The importance of patient selection in nonmyeloablative stem cell transplant (NMSCT) for acute and chronic leukaemia, myelodysplastic syndrome, and myeloma

M. Lalancette, M. Michailet, R. Szydlo, K. Rezvani, S. Mackinnon, D. Biaise, J. Finke, S. Slavin, E. P. Alessandrino, D. Niederwieser, F. Frassoni, G. Gahrton, J. Apperley

Research output: Contribution to journalArticlepeer-review

Abstract

Between April 1994 and May 2000, 256 patients received a NMSCT for acute and chronic leukemia, myeloma and MDS in 33 centres of the EBMT. Data are available for 65 patients with AML, 36 ALL, 46 CML, 10 CLL, 49 MDS, and 50 myeloma. Median age was 50.3 years (3-68), and 145 were males. 30% were good risk at the time of transplant i.e. CML CP1, AML CR1-2, ALL CR1, myeloma CR1-PR1, CLL CR1/PR1, and MDS RA/RAS. 202 received grafts from HLA identical siblings, 23 from MUD, and 18 from mismatched family or unrelated donors. 171 patients were transplanted with PBSC, 63 with BM, and 3 received both. Most patients (240) received fludarabine based conditioning, 111 with busulphan, and 79 with melphalan. Cyclosporin was used in 238 transplants, and serotherapy in 174 patients (ATG/ALG 139, Campath 35). 12 patients did not engraft. The median times to neutrophil (0.5 X 10 exp9/L) and platelet (50 X 10 exp9/ L) engraftment were 15 and 17 days respectively. The 100 day mortality was 22%. GVHD grade II-IV occured in 28%. Chimerism data were available from 190 patients, and 76% showed full donor chimerism. DL1 was used in 41 patients, the vast majority because of disease persistence/relapse. The actuarial survivals (OS) for the whole cohort at 6, 12, and 24 months were 63%, 49%, and 39% respectively. OS at one year for CML, CLL, AML, ALL, MDS and myeloma, were 65%, 83%, 41%, 15%, 65%, and 54% respectively. The one year OS for the good and poor risk patients as defined above were 61% and 40% (p=0.0002). However the outcome for patients with ALL was particularly poor. If ALL CR1 was excluded from the good risk group then the OS, TRM, and relapse rate rate at one year were 71%, 13%, and 6%, compared with 45%, 36%, and 28% for the poor risk group. In conclusion, NMSCT is a useful alternative to conventional SCT in this cohort of older patients. Further follow-up will be required to identify the long term benefit of these procedures with respect to disease free survival. Patients with ALL do not appear to benefit from NMSCT at any stage of their disease.

Original languageEnglish
JournalBlood
Volume96
Issue number11 PART I
Publication statusPublished - 2000

ASJC Scopus subject areas

  • Hematology

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