Feasibility of Second Hematopoietic Stem Cell Transplantation Using Reduced-Intensity Conditioning with Fludarabine and Melphalan after a Failed Autologous Hematopoietic Stem Cell Transplantation

Abstract This study was performed to determine the feasibility of second hematopoietic stem cell transplantation (HSCT) using reduced-intensity conditioning (RIC) with fludarabine and melphalan in patients with relapsed hematologic malignancies after a prior autologous HSCT. Twelve patients (multipl...

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Bibliographic Details
Published in:Transplantation proceedings 2010-11, Vol.42 (9), p.3723-3728
Main Authors: Hong, J.Y, Choi, M.K, Kim, D.H, Kim, S.J, Kim, K, Kim, W.S, Chung, C.W, Kim, H.O, Min, Y.H, Jang, J.H
Format: Article
Language:English
Subjects:
Adult
Biological and medical sciences
Disease-Free Survival
Feasibility Studies
Female
Fundamental and applied biological sciences. Psychology
Fundamental immunology
Graft vs Host Disease - etiology
Hematopoietic Stem Cell Transplantation - adverse effects
Hematopoietic Stem Cell Transplantation - mortality
Humans
Kaplan-Meier Estimate
Leukemia, Myeloid, Acute - mortality
Leukemia, Myeloid, Acute - surgery
Lymphoma, Non-Hodgkin - mortality
Lymphoma, Non-Hodgkin - surgery
Male
Medical sciences
Melphalan - adverse effects
Melphalan - therapeutic use
Middle Aged
Multiple Myeloma - mortality
Multiple Myeloma - surgery
Myeloablative Agonists - adverse effects
Myeloablative Agonists - therapeutic use
Recurrence
Reoperation
Republic of Korea
Retrospective Studies
Salvage Therapy
Surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Survival Rate
Time Factors
Tissue, organ and graft immunology
Transplantation Chimera
Transplantation Conditioning - adverse effects
Transplantation Conditioning - methods
Transplantation, Autologous
Treatment Failure
Vidarabine - adverse effects
Vidarabine - analogs & derivatives
Vidarabine - therapeutic use
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Summary:Abstract This study was performed to determine the feasibility of second hematopoietic stem cell transplantation (HSCT) using reduced-intensity conditioning (RIC) with fludarabine and melphalan in patients with relapsed hematologic malignancies after a prior autologous HSCT. Twelve patients (multiple myeloma [n = 7], non-Hodgkin lymphoma [n = 3], and acute myeloid leukemia [n = 2] received allogeneic HSCT using RIC with fludarabine (25 mg/m2 for 5 days) and melphalan (140 mg/m2 for 1 day) after a failed autologous HSCT. The graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporine plus a minidose of methotrexate. All patients achieved a neutrophil and platelet engraftment in a median 13.5 days and 17.5 days, respectively. The transplant-related mortality was 2 patients (16.7%). Grade II-IV acute GVHD and chronic extensive GVHD were noted in 4 (33.3%) and 1 patient (11.1%), respectively. Over a median follow-up duration of 376 days, 5 patients were alive without evidence of disease. The estimated nonrelapse mortality at 1 year was 28.4%. The estimated overall survival rate at 1 year was 58.3%, and the estimated event- free survival rate at 1 year was 41.7%. Allogeneic HSCT using RIC with fludarabine and melphalan appears to be feasible for a second HSCT in patients with relapsed hematologic malignancies after a failed autologous HSCT.
ISSN:0041-1345
1873-2623
DOI:10.1016/j.transproceed.2010.09.005