Autografting followed by allografting with nonmyeloablative regimen is a safe and effective procedure for advanced hematological neoplasias and breast cancer

A. M. Carella, E. Lerma, A. Deiana

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Abstract

The objective of this study was to assess the feasibility of achieving the engraftinent of allogeneic hematopoietic progenitor cells (HPC) after nonmyeloablative regimen in patients with hematological neoplasias and breast cancer. Thirteen patients with a median age of 38 years (range, 22-57) were treated- Four patients had advanced resistant Hodgkin's Disease (HD), two patients Non-Hodgkin's lymphoma (NHL), four patients metastatic breast cancer in bone and liver, two patients chronic myelogenous leukemia in accelerated and blastic phase and one patient had RAEB with 1(1 ;3) in all metaphases With the exception of RAEB patient, who received only allografting, all other patients were previously treated with autografting in the attempt to reduce the tumor burden before allografting. After engraftment of autologous stem cells, all patients received fludarabine (30 mg/m /d x 3 days) with Cyclophosphamide (300 mg/m /d x 3 days) (Flu-Cy protocol). Two days after, mobilized HLA-matched sibling HPC were infused. GVHD prophylaxis consisted of CSA and MTX. The median follow up is 108 days (range, 43-300). Graft failure occurred in one patient. Acute GVHD of grade >2 severity was observed in four patients. Flu-Cy protocol was extremely well tolerated with only two patients experiencing grade 2 nausea and vomiting. Only two patients achieved ANC lower than 1x10VL but none patient achieved platelets lower than 20x10'VL After autografting, 7 patients achieved partial remission (Lymphomas: 5 patients; Breast Cancer 2 patients) and both patients with CML achieved a second Ph-positive chronic phase. After allografting, 3 patients achieved complete remission (Lymphomas: 2 patients; Breast Cancer: 1 patient) and another patient with CML acquired decreasing BCR-ABL/ABL ratio (0.001). The median duration of CR is 40 days (range, 30-180). Chimerism analysis on bone marrow cells in all patients achieving remission showed 100% donor cells between 45 and 90 days postinfusion. We conclude that Flu-Cy protocol is a well tolerated, safe and effective mmiunosuppressive regimen able to allow the engraftment of HLA-matched sibling donor cells; moreover, this procedure allows to explore graft versus tumor effect without the toxicity of conventional myeloablative therapy even after debulky with high-dose therapy/autografting.

Original languageEnglish
Pages (from-to)701
Number of pages1
JournalExperimental Hematology
Volume26
Issue number8
Publication statusPublished - 1998

ASJC Scopus subject areas

  • Cancer Research
  • Cell Biology
  • Genetics
  • Hematology
  • Oncology
  • Transplantation

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