Allogeneic Peripheral Blood Stem Cell Transplantation Using Reduced Intensity Versus Myeloablative Conditioning Regimens for the Treatment of Leukemia

Abstract

Reduced intensity conditioning (RIC) have allowed the application of transplantation to older patients and to patients with underlying medical problems. Between October, 1999, and June, 2003, 61 patients with acute leukemia or chronic myeloid leukemia received allogeneic peripheral blood hematopoietic stem cell transplantation (HSCT) from HLA-identical siblings. Thirty-four were conditioned with myeloablative protocols and twenty-seven with RIC regimens. The patients in the myeloablative group were younger (29 vs. 37 years; p < 0.0003), most of them were transplanted in complete remission (74% vs. 59%; p < 0.03), had a shorter interval between diagnosis and HSCT (12 vs. 21 months; p < 0.02) and a greater proportion belonged to standard-risk prognosis (68% vs. 48%; p < 0.1). The median times to neutrophil, platelet and red blood cell engraftment for the myeloablative and RIC groups were 14 versus 11 days (p < 0.009), 17 versus 9 days (p < 0.0001), and 19 versus 12 days (p < 0.007), respectively. Transfusion requirements were lower in the RIC group. Severe mucositis was present in 32% and 7%, respectively (p < 0.01). The proportion of patients having acute graft versus-disease (GVHD), chronic GVHD, and infections was the same, as well as early and late mortality, disease-free survival, and overall survival. Analyzing all the patients together, three factors significantly influenced overall survival: standard risk patients, complete remission at transplant, and the absence of severe acute GVHD. In conclusion, our data suggest that even in high-risk patients, RIC transplantation seems to be as useful as ablative HSCT.

Mobilization, harvesting and selection of peripheral blood stem cells in patients with autoimmune diseases undergoing autologous hematopoietic stem cell transplantation

“…Following allogeneic HSCT for malignancies, only a few retrospective studies have reported on engraftment interval which generally report earlier WBC and/or platelet recovery using reduced intensity regimens compared to conventional myeloablative protocols. 53,54 In summary, our retrospective study indicates the mobilization of PBSC may be performed safely without significant risk of disease exacerbation using cyclophosphamide and G-CSF mobilization but that astute and close observation and prophylaxis for infectious complica-tions is prudent with immune-mediate diseases. Circulating post-mobilization PB CD34 þ cell numbers vary between autoimmune diseases.…”

Incidence, risk factors, and outcome of bloodstream infections during the pre‐engraftment phase in 521 allogeneic hematopoietic stem cell transplantations

“…One major reason for this is probably that the time to engraftment is not necessarily equivalent to the duration of neutropenia. Some patients undergoing RIC do not reach an absolute neutrophil count of <0.5 × 10 9 /L until after stem cell infusion, and some of these patients never become profoundly neutropenic, i.e., never have a count of <0.1 × 10 9 /L . Another possible explanation is that the time to engraftment is related to stem cell source and human leukocyte antigen mismatch, making it difficult to separate these factors in the multivariate analysis.…”

Allogeneic Stem Cell Transplantation for Patients with Advanced Hematological Malignancies: Comparison of Fludarabine-based Reduced Intensity Conditioning versus Myeloablative Conditioning

“…However, some investigators have reported similar cumulative NRM incidence rates (4, 6). We detected no differences in the NRM incidence rates between the groups in this study (47% vs. 56%), although our study involved a somewhat higher incidence rate than was reported in previous studies.…”

“…Some investigators have reported lower acute GVHD incidence rates in cases of reduced intensity transplantation (21), while contradictory results also exist (3, 5, 6). The diversity of conditioning regimens, stem cell sources, and GVHD prophylaxis protocols in reduced intensity transplantation might be one reason for this discrepancy.…”