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Partially matched, nonmyeloablative allogeneic transplantation: clinical outcomes and immune reconstitution.

Publication ,  Journal Article
Rizzieri, DA; Koh, LP; Long, GD; Gasparetto, C; Sullivan, KM; Horwitz, M; Chute, J; Smith, C; Gong, JZ; Lagoo, A; Niedzwiecki, D; Dowell, JM ...
Published in: J Clin Oncol
February 20, 2007

PURPOSE: Allogeneic transplantation is typically limited to younger patients having a matched donor. To allow a donor to be found for nearly all patients, we have used a nonmyeloablative conditioning regimen in conjunction with stem cells from a related donor with one fully mismatched HLA haplotype. PATIENTS AND METHODS: Fludarabine, cyclophosphamide, and alemtuzumab were used as the preparatory regimen. Additional graft-versus-host disease (GVHD) prophylaxis included mycophenolate with or without cyclosporine. Patients with persistence of disease had a donor lymphocyte boost planned. Toxicities, engraftment, response, survival, and immune recovery are reported. RESULTS: Forty-nine patients with hematologic malignancies or marrow failure and no other available donors were enrolled. Ninety-four percent of patients had successful engraftment, and 8% had secondary graft failure. The treatment-related mortality rate was 10.2%, and 8% of patients had severe GVHD. Encouraging evidence of quantitative lymphocyte recovery through expansion of transplanted T cells was noted by 3 to 6 months. Seventy-five percent of patients attained a complete remission, and 1-year survival rate was 31% (95% CI, 18% to 44%). A standard-risk group of 19 patients with aplasia or in remission at transplantation demonstrated a 63% 1-year survival rate (95% CI, 38% to 80%) and 2.9-year median overall survival time (95% CI, 6.2 to 48 months). CONCLUSION: Nonmyeloablative therapy using haploidentical family member donors is feasible because the main obstacles of GVHD and graft rejection are manageable, allowing readily available stem-cell donors to be found for nearly all patients. Further qualitative and quantitative improvement in immune recovery is needed to address the high rate of relapse and risk of severe infections.

Duke Scholars

Published In

J Clin Oncol

DOI

EISSN

1527-7755

Publication Date

February 20, 2007

Volume

25

Issue

6

Start / End Page

690 / 697

Location

United States

Related Subject Headings

  • Transplantation, Homologous
  • Transplantation Immunology
  • Transplantation Conditioning
  • Survival Analysis
  • Risk Assessment
  • Prospective Studies
  • Oncology & Carcinogenesis
  • Myeloablative Agonists
  • Middle Aged
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
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Rizzieri, D. A., Koh, L. P., Long, G. D., Gasparetto, C., Sullivan, K. M., Horwitz, M., … Chao, N. J. (2007). Partially matched, nonmyeloablative allogeneic transplantation: clinical outcomes and immune reconstitution. J Clin Oncol, 25(6), 690–697. https://doi.org/10.1200/JCO.2006.07.0953
Rizzieri, David A., Liang Piu Koh, Gwynn D. Long, Cristina Gasparetto, Keith M. Sullivan, Mitchell Horwitz, John Chute, et al. “Partially matched, nonmyeloablative allogeneic transplantation: clinical outcomes and immune reconstitution.J Clin Oncol 25, no. 6 (February 20, 2007): 690–97. https://doi.org/10.1200/JCO.2006.07.0953.
Rizzieri DA, Koh LP, Long GD, Gasparetto C, Sullivan KM, Horwitz M, et al. Partially matched, nonmyeloablative allogeneic transplantation: clinical outcomes and immune reconstitution. J Clin Oncol. 2007 Feb 20;25(6):690–7.
Rizzieri, David A., et al. “Partially matched, nonmyeloablative allogeneic transplantation: clinical outcomes and immune reconstitution.J Clin Oncol, vol. 25, no. 6, Feb. 2007, pp. 690–97. Pubmed, doi:10.1200/JCO.2006.07.0953.
Rizzieri DA, Koh LP, Long GD, Gasparetto C, Sullivan KM, Horwitz M, Chute J, Smith C, Gong JZ, Lagoo A, Niedzwiecki D, Dowell JM, Waters-Pick B, Liu C, Marshall D, Vredenburgh JJ, Gockerman J, Decastro C, Moore J, Chao NJ. Partially matched, nonmyeloablative allogeneic transplantation: clinical outcomes and immune reconstitution. J Clin Oncol. 2007 Feb 20;25(6):690–697.

Published In

J Clin Oncol

DOI

EISSN

1527-7755

Publication Date

February 20, 2007

Volume

25

Issue

6

Start / End Page

690 / 697

Location

United States

Related Subject Headings

  • Transplantation, Homologous
  • Transplantation Immunology
  • Transplantation Conditioning
  • Survival Analysis
  • Risk Assessment
  • Prospective Studies
  • Oncology & Carcinogenesis
  • Myeloablative Agonists
  • Middle Aged
  • Male