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Conditioning Regimens

Reduced-intensity conditioning using fludarabine, melphalan and thiotepa for adult patients undergoing haploidentical SCT

Bone Marrow Transplantation volume 45, pages 429–436 (2010)Cite this article

Abstract

Haploidentical SCT (HaploSCT) has been most commonly performed using a myeloablative, TBI-based preparative regimen; however, the toxicity with this approach remains very high. We studied the feasibility of a reduced-intensity conditioning regimen in a phase II clinical trial using fludarabine, melphalan and thiotepa and antithymocyte globulin (ATG) for patients with advanced hematological malignancies undergoing T-cell depleted HaploSCT. Twenty-eight patients were entered in the study. Engraftment with donor-derived hematopoiesis was achieved in 78% of patients after a median of 13 days. Six patients experienced primary graft failure, three out of four tested patients had donor-specific anti-HLA antibodies (DSA) (P=0.001). Toxicity included mostly infections. A total of 21 out of 22 patients with AML/myelodysplastic syndrome (MDS) achieved remission after transplant (16 with relapsed/refractory AML). Five out of the 12 patients (42%) with AML/MDS with <15% BM blasts survived long term as compared with none with more advanced disease (P=0.03). HaploSCT with this fludarabine, melphalan and thiotepa and ATG RIC is an effective, well-tolerated conditioning regimen for patients with AML/MDS with low disease burden at the time of transplant and allowed a high rate of engraftment in patients without DSA. Patients with overt relapse fared poorly and require novel treatment strategies.

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Acknowledgements

We thank all our pharmacists, transplant coordinators and nursing staff for their dedication to patient care; research nurses, technicians and laboratory personnel who contributed to the collection, recording and reporting of the data.

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Authors and Affiliations

  1. Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    S O Ciurea, R Saliba, G Rondon, S Qureshi, J McMannis, P Kebriaei, R B Jones, M Korbling, M Qazilbash, E J Shpall, S Giralt, M de Lima & R E Champlin

  2. HLA Laboratory, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    S Pesoa, P Cano & M Fernandez-Vina

  3. Department of Pediatrics, Children's Cancer Hospital, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    L L Worth

  4. Division of Hematology/Oncology, Department of Medicine, Oregon Health and Science University, Portland, OR, USA

    J Gajewski

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  1. S O Ciurea
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  2. R Saliba
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  7. S Qureshi
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  9. J McMannis
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  10. P Kebriaei
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  11. R B Jones
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  12. M Korbling
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  13. M Qazilbash
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  14. E J Shpall
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  15. S Giralt
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  16. M de Lima
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  17. R E Champlin
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  18. J Gajewski
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Correspondence to S O Ciurea.

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Ciurea, S., Saliba, R., Rondon, G. et al. Reduced-intensity conditioning using fludarabine, melphalan and thiotepa for adult patients undergoing haploidentical SCT. Bone Marrow Transplant 45, 429–436 (2010). https://doi.org/10.1038/bmt.2009.189

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  • DOI: https://doi.org/10.1038/bmt.2009.189

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