Clinical effect of reduced-intensity conditioning regimen containing antithymocyte globulin for hematopoietic cell transplantation from unrelated-donors

Title
Clinical effect of reduced-intensity conditioning regimen containing antithymocyte globulin for hematopoietic cell transplantation from unrelated-donors
Author(s)
김민경현명수이규형[이규형]최성준[최성준]이제환[이제환]이정희[이정희]김대영[김대영]설미이[설미이]이영신[이영신]강영아[강영아]윤성철[윤성철]주영돈[주영돈]이원식[이원식]강명주[강명주]김혁[김혁]박재후[박재후]배성화[배성화]류헌모[류헌모]
Keywords
VERSUS-HOST-DISEASE; BONE-MARROW-TRANSPLANTATION; ACUTE MYELOID-LEUKEMIA; TOTAL-BODY IRRADIATION; HEMATOLOGIC MALIGNANCIES; HLA-A; ALLOGENEIC TRANSPLANTATION; ELDERLY-PATIENTS; APLASTIC-ANEMIA; PROPHYLAXIS
Issue Date
201105
Publisher
WILEY-BLACKWELL
Citation
AMERICAN JOURNAL OF HEMATOLOGY, v.86, no.5, pp.399 - 405
Abstract
The impact of reduced-intensity conditioning (RIC) on the outcomes of hematopoietic cell transplantation (HCT) from unrelated -donors (UD) remains to be determined. We therefore assessed 128 patients, aged 16 to 66 years, with acute leukemia (n = 105) or myelodysplastic syndrome (n = 23) in a UD-HCT trial using RIC with busulfan, fludarabine, and antithymocyte globulin. Patients were transplanted with unmanipulated bone marrow (BM, n = 41) or mobilized peripheral blood mononuclear cells (M-PB, n = 87) and received cyclosporine and methotrexate for graft-versus-host disease (GVHD) prophylaxis. After a median follow-up of 26.7 months (range, 5.9-70.7 months) in surviving patients, 19 patients had died without progression/recurrence of underlying disease, giving a cumulative incidence of transplantation-related mortality (TRM) of 17% (95% confidence interval, 11%-27%; 1-year TRM, 14%). Graft failure (n = 7) and infections (n = 5) were the most common causes of TRM. Only three patients died due to GVHD (acute, one; chronic, two). Graft failure, which occurred in eight patients, showed a significant correlation with graft source (BM, 6/41 vs. M-PB, 2/87; P = 0.009). Donor-patient HLA-disparity did not correlate with GVHD, 1-year TRM, and graft failure. RIC containing antithymocyte globulin led to decreased GVHD-associated, as well as overall, TRM after UD-HCT. This trial is registered at www.clinicaltrials.gov as NCT00627666. Am. J. Hematol. 86:399-405, 2011. (C) 2011 Wiley-Liss, Inc.
URI
http://hdl.handle.net/YU.REPOSITORY/25216http://dx.doi.org/10.1002/ajh.21989
ISSN
0361-8609
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의과대학 > 내과학교실 > Articles
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