Reference : Graft-versus-tumor effects after allogeneic hematopoietic cell transplantation with n...
Scientific journals : Article
Human health sciences : Hematology
Human health sciences : Oncology
Graft-versus-tumor effects after allogeneic hematopoietic cell transplantation with nonmyeloablative conditioning
Baron, Frédéric mailto [Université de Liège - ULiège > Département des sciences cliniques > Hématologie]
Maris, M. B. [> > > >]
Sandmaier, B. M. [> > > >]
Storer, B. E. [> > > >]
Sorror, M. [> > > >]
Diaconescu, R. [> > > >]
Woolfrey, A. E. [> > > >]
Chauncey, T. R. [> > > >]
Flowers, M. E. D. [> > > >]
Mielcarck, M. [> > > >]
Maloney, D. G. [> > > >]
Storb, R. [> > > >]
Journal of Clinical Oncology
Amer Soc Clinical Oncology
Yes (verified by ORBi)
[en] Purpose We have used a nonmyelorablative conditioning regimen consisting of total-body irradiation (2 Gy) with or without fludarabine (30 mg/m(2)/d for 3 days) for related and unrelated hematopoietic cell transplantation (HCT) in patients with hematologic malignancies who were not candidates for conventional HCT because of age, medical comorbidities, or preceding high-dose HCT. This approach relied on graft-versus-tumor (GVT) effects for control of malignancy. Patients and Methods We analyzed GVT effects in 322 patients given grafts from HILA-matched related (n = 192) or unrelated donors (n = 130). Results Of the 221 patients with measurable disease at HCT, 126 (57%) achieved complete (n = 98) or partial (n = 28) remissions. In multivariate analysis, there was a higher probability trend of achieving complete remissions in patients with chronic extensive graft-versus-host disease (GVHD, P = .07). One hundred eight patients (34%) relapsed or progressed. In multivariate analysis, achievement of full donor chimerism was associated with a decreased risk of relapse or progression (P = .002). Grade 2 to 4 acute GVHD had no significant impact on the risk of relapse or progression but was associated with increased risk of nonrelapse mortality and decreased probability of progression-free survival (PFS). Conversely, extensive chronic GVHD was associated with decreased risk of relapse or progression (P = .006) and increased probability of PFS (P = .003). Conclusion New approaches aimed at reducing the incidence of grade 2 to 4 acute GVHD might improve survival after allogeneic HCT after nonmyeloablative conditioning. (c) 2005 by American Society of Clinical Oncology.

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