Reduced-intensity stem cell transplantation from an HLA-identical sibling donor in patients with myeloid malignancies

T. Hamaki, M. Kami, S. W. Kim, Y. Onishi, Y. Kishi, N. Murashige, A. Hori, R. Kojima, M. Sakiyama, O. Imataki, Y. Heike, Ryuji Tanosaki, S. Masuo, S. Miyakoshi, S. Taniguchi, K. Tobinai, Y. Takaue

Research output: Contribution to journalArticle

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Abstract

The purpose of this study was to evaluate the feasibility and efficacy of allogeneic hematopoietic stem cell transplantation with a reduced-intensity regimen (RIST) in patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS). In all, 36 patients (median age 55 years) underwent RIST from an HLA-matched related donor between September 1999 and December 2002. The diagnoses included AML (n = 14), leukemia evolving from MDS (n = 10), and MDS (refractory anemia with excess blasts n = 6, refractory anemia n = 6). The RIST regimen consisted of purine analog (cladribine or fludarabine)/busulfan, with or without antithymocyte globulin. The regimen was well tolerated, and 34 patients achieved durable engraftment and most achieved remission after RIST. A total of 17 patients developed grade II-IV acute GVHD, and 27 developed chronic GVHD. Eight patients relapsed, and five of them received antithymocyte globulin (ATG) as part of the preparative regimen. A total of 12 patients died (four disease progression, six transplantation-related complications, and two others). Estimated 1-year disease-free survival (DFS) in low- and high-risk groups was 85 and 64%, respectively. We conclude that RIST can be performed safely in elderly patients with myeloid malignancies, and has therapeutic potential for those who fail conventional chemotherapy. In view of the significant association between GVHD or ATG and DFS, defined management of GVHD following RIST should become a major target of clinical research.

Original languageEnglish
Pages (from-to)891-900
Number of pages10
JournalBone Marrow Transplantation
Volume33
Issue number9
DOIs
Publication statusPublished - 2004 May
Externally publishedYes

Fingerprint

Stem Cell Transplantation
Siblings
Tissue Donors
Antilymphocyte Serum
Myelodysplastic Syndromes
Neoplasms
Acute Myeloid Leukemia
Disease-Free Survival
Cladribine
Refractory Anemia with Excess of Blasts
Refractory Anemia
Busulfan
Hematopoietic Stem Cell Transplantation
Disease Progression
Leukemia
Transplantation
Drug Therapy
Research

Keywords

  • Acute myeloid leukemia
  • Graft-versus-host disease
  • Graft-versus-leukemia effect
  • Myelodysplastic syndrome
  • Reduced-intensity hematopoietic stem cell transplantation

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Reduced-intensity stem cell transplantation from an HLA-identical sibling donor in patients with myeloid malignancies. / Hamaki, T.; Kami, M.; Kim, S. W.; Onishi, Y.; Kishi, Y.; Murashige, N.; Hori, A.; Kojima, R.; Sakiyama, M.; Imataki, O.; Heike, Y.; Tanosaki, Ryuji; Masuo, S.; Miyakoshi, S.; Taniguchi, S.; Tobinai, K.; Takaue, Y.

In: Bone Marrow Transplantation, Vol. 33, No. 9, 05.2004, p. 891-900.

Research output: Contribution to journalArticle

Hamaki, T, Kami, M, Kim, SW, Onishi, Y, Kishi, Y, Murashige, N, Hori, A, Kojima, R, Sakiyama, M, Imataki, O, Heike, Y, Tanosaki, R, Masuo, S, Miyakoshi, S, Taniguchi, S, Tobinai, K & Takaue, Y 2004, 'Reduced-intensity stem cell transplantation from an HLA-identical sibling donor in patients with myeloid malignancies', Bone Marrow Transplantation, vol. 33, no. 9, pp. 891-900. https://doi.org/10.1038/sj.bmt.1704477
Hamaki, T. ; Kami, M. ; Kim, S. W. ; Onishi, Y. ; Kishi, Y. ; Murashige, N. ; Hori, A. ; Kojima, R. ; Sakiyama, M. ; Imataki, O. ; Heike, Y. ; Tanosaki, Ryuji ; Masuo, S. ; Miyakoshi, S. ; Taniguchi, S. ; Tobinai, K. ; Takaue, Y. / Reduced-intensity stem cell transplantation from an HLA-identical sibling donor in patients with myeloid malignancies. In: Bone Marrow Transplantation. 2004 ; Vol. 33, No. 9. pp. 891-900.
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abstract = "The purpose of this study was to evaluate the feasibility and efficacy of allogeneic hematopoietic stem cell transplantation with a reduced-intensity regimen (RIST) in patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS). In all, 36 patients (median age 55 years) underwent RIST from an HLA-matched related donor between September 1999 and December 2002. The diagnoses included AML (n = 14), leukemia evolving from MDS (n = 10), and MDS (refractory anemia with excess blasts n = 6, refractory anemia n = 6). The RIST regimen consisted of purine analog (cladribine or fludarabine)/busulfan, with or without antithymocyte globulin. The regimen was well tolerated, and 34 patients achieved durable engraftment and most achieved remission after RIST. A total of 17 patients developed grade II-IV acute GVHD, and 27 developed chronic GVHD. Eight patients relapsed, and five of them received antithymocyte globulin (ATG) as part of the preparative regimen. A total of 12 patients died (four disease progression, six transplantation-related complications, and two others). Estimated 1-year disease-free survival (DFS) in low- and high-risk groups was 85 and 64{\%}, respectively. We conclude that RIST can be performed safely in elderly patients with myeloid malignancies, and has therapeutic potential for those who fail conventional chemotherapy. In view of the significant association between GVHD or ATG and DFS, defined management of GVHD following RIST should become a major target of clinical research.",
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AU - Hamaki, T.

AU - Kami, M.

AU - Kim, S. W.

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AU - Kishi, Y.

AU - Murashige, N.

AU - Hori, A.

AU - Kojima, R.

AU - Sakiyama, M.

AU - Imataki, O.

AU - Heike, Y.

AU - Tanosaki, Ryuji

AU - Masuo, S.

AU - Miyakoshi, S.

AU - Taniguchi, S.

AU - Tobinai, K.

AU - Takaue, Y.

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N2 - The purpose of this study was to evaluate the feasibility and efficacy of allogeneic hematopoietic stem cell transplantation with a reduced-intensity regimen (RIST) in patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS). In all, 36 patients (median age 55 years) underwent RIST from an HLA-matched related donor between September 1999 and December 2002. The diagnoses included AML (n = 14), leukemia evolving from MDS (n = 10), and MDS (refractory anemia with excess blasts n = 6, refractory anemia n = 6). The RIST regimen consisted of purine analog (cladribine or fludarabine)/busulfan, with or without antithymocyte globulin. The regimen was well tolerated, and 34 patients achieved durable engraftment and most achieved remission after RIST. A total of 17 patients developed grade II-IV acute GVHD, and 27 developed chronic GVHD. Eight patients relapsed, and five of them received antithymocyte globulin (ATG) as part of the preparative regimen. A total of 12 patients died (four disease progression, six transplantation-related complications, and two others). Estimated 1-year disease-free survival (DFS) in low- and high-risk groups was 85 and 64%, respectively. We conclude that RIST can be performed safely in elderly patients with myeloid malignancies, and has therapeutic potential for those who fail conventional chemotherapy. In view of the significant association between GVHD or ATG and DFS, defined management of GVHD following RIST should become a major target of clinical research.

AB - The purpose of this study was to evaluate the feasibility and efficacy of allogeneic hematopoietic stem cell transplantation with a reduced-intensity regimen (RIST) in patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS). In all, 36 patients (median age 55 years) underwent RIST from an HLA-matched related donor between September 1999 and December 2002. The diagnoses included AML (n = 14), leukemia evolving from MDS (n = 10), and MDS (refractory anemia with excess blasts n = 6, refractory anemia n = 6). The RIST regimen consisted of purine analog (cladribine or fludarabine)/busulfan, with or without antithymocyte globulin. The regimen was well tolerated, and 34 patients achieved durable engraftment and most achieved remission after RIST. A total of 17 patients developed grade II-IV acute GVHD, and 27 developed chronic GVHD. Eight patients relapsed, and five of them received antithymocyte globulin (ATG) as part of the preparative regimen. A total of 12 patients died (four disease progression, six transplantation-related complications, and two others). Estimated 1-year disease-free survival (DFS) in low- and high-risk groups was 85 and 64%, respectively. We conclude that RIST can be performed safely in elderly patients with myeloid malignancies, and has therapeutic potential for those who fail conventional chemotherapy. In view of the significant association between GVHD or ATG and DFS, defined management of GVHD following RIST should become a major target of clinical research.

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