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Conditioning Regimens

Regimen-related toxicity after fludarabine–melphalan conditioning: a prospective study of 31 patients with hematologic malignancies

Bone Marrow Transplantation volume 32, pages 471–476 (2003)Cite this article

Summary:

A total of 31 consecutive patients with hematologic malignancies who were considered poor candidates for TBI underwent allogeneic stem cell transplantation after conditioning with fludarabine and melphalan. A total of 25 matched sibling recipients received fludarabine 25 mg/m2 × 5 days and melphalan 70 mg/m2 × 2 days. For unrelated and haploidentical donor recipients, fludarabine was increased to 30 mg/m2 and ATG 30 mg/kg × 4 days was added. Graft-versus-host disease prophylaxis consisted of tacrolimus and mini methotrexate. All patients engrafted. Regimen-related toxicity was considerable and included mainly renal, hepatic and mucosal toxicity. There were seven regimen-related-deaths including two VOD, two pulmonary, one renal, one cardiac and one mucosal toxicity. One case of fatal pulmonary toxicity death could be attributed to pre-existing pulmonary damage. Progression-free survival at 12 months was 44% (90% CI: 30–58%) for recipients of HLA-identical sibling transplants and 33% (90% CI: 21–45%) for all patients. In conclusion, the fludarabine–melphalan regimen leads to consistent engraftment. The regimen-related toxicity is considerable and cannot be explained solely by patient selection. Cardiac toxicity is emerging as a unique toxicity of this regimen. Despite toxicity, fludarabine–melphalan has considerable activity and leads to durable remission in a proportion of patients.

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Authors and Affiliations

  1. University of Illinois at Chicago, Chicago, IL, USA

    K van Besien, S Devine, A Wickrema, E Jessop, K Amin, M Yassine, V Maynard, W Stock, D Peace, F Ravandi, Y-H Chen, R Hoffman & J Sossman

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  1. K van Besien
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  2. S Devine
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  3. A Wickrema
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Supported in part by a grant from Berlex Pharmaceuticals

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van Besien, K., Devine, S., Wickrema, A. et al. Regimen-related toxicity after fludarabine–melphalan conditioning: a prospective study of 31 patients with hematologic malignancies. Bone Marrow Transplant 32, 471–476 (2003). https://doi.org/10.1038/sj.bmt.1704166

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