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

Abstract

We compared the outcomes of allogeneic hematopoietic stem cell transplantation using reduced intensity and myeloablative conditioning for the treatment of patients with advanced hematological malignancies. A total of 75 adult patients received transplants from human leukocyte antigen-matched donors, coupled with either reduced intensity (n=40; fludarabine/melphalan, 28; fludarabine/cyclophosphamide, 12) or myeloablative conditioning (n=35, busufan/cyclophosphamide). The patients receiving reduced intensity conditioning were elderly, or exhibited contraindications for myeloablative conditioning. Neutrophil and platelet engraftment occurred more rapidly in the reduced intensity group (median, 9 days vs. 18 days in the myeloablative group, p<0.0001; median 12 days vs. 22 days in the myeloablative group, p=0.0001, respectively). Acute graft-versus-host disease (≥grade II) occurred at comparable frequencies in both groups, while the incidence of hepatic veno-occlusive disease was lower in the reduced intensity group (3% vs. 20% in the myeloablative group, p=0.02). The overall 1-yr survival rates of the reduced intensity and myeloablative group patients were 44% and 15%, respectively (p=0.16). The results of present study indicate that patients with advanced hematological malignancies, even the elderly and those with major organ dysfunctions, might benefit from reduced intensity transplantation.

Comparison of reduced intensity and myeloablative conditioning regimens for stem cell transplantation in patients with malignancies: a meta‐analysis

“…Bibliographic search yielded 1779 articles, of which 1735 were excluded. Among the rest 44 articles, two for review data, eight for absence of control group, and five for the absence of statistical data were excluded in all 29 complete data studies (10–38) totaling 6235 patients to include in meta‐analyses (Fig. 1).…”

Características biológicas das células-tronco mesenquimais

“…83 As aplicações clínicas de células tronco/progenitoras CD34+ consistem em transplante tanto alogênico (malignidades hematopoéticas, imunodeficiências, aplasia de medula óssea, doenças do metabolismo, hemoglobinopatias) como autólogo (leucemias agudas, mielomas, linfomas, câncer de mama e de ovário, tumor de célula germinativa, doenças autoimunes). [84][85][86][87][88][89][90][91] As MSCs têm também atuação na imunidade. As células-tronco mesenquimais têm ações imunorregulatórias e interagem com todas as células envolvidas na resposta imune.…”

Nation-Wide Retrospective Analysis of Allogeneic Stem Cell Transplantation in Patients with Multiple Myeloma: A Study from Korean Multiple Myeloma Working Party (KMM1913)

“…Our results were comparable with previous studies where 5-year OS was approximately 60% in alloSCT used as a firstline therapy [ 19 , 20 ] and 30% in subsequent lines [ 21 ]. Another study revealed that heavily pretreated patients showed significantly worse survival after alloSCT while early intervention had relatively less toxicity, leading to lower NRM [ 22 ]. Therefore, earlier implementation of alloSCT may lead to better survival outcomes.…”