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Blood, 1 August 2004, Vol. 104, No. 3, pp. 865-872. Prepublished online as a Blood First Edition Paper on April 15, 2004; DOI 10.1182/blood-2003-11-3750. This Article Full Text Full Text (PDF) All Versions of this Article: 2003-11-3750v1 104/3/865    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by de Lima, M. Articles by Giralt, S. Search for Related Content PubMed PubMed Citation Articles by de Lima, M. Articles by Giralt, S. Related Collections Neoplasia Transplantation Clinical Trials and Observations Related Article in Blood Online Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  TRANSPLANTATION Nonablative versus reduced-intensity conditioning regimens in the treatment of acute myeloid leukemia and high-risk myelodysplastic syndrome: dose is relevant for long-term disease control after allogeneic hematopoietic stem cell transplantation Marcos de Lima, Athanasios Anagnostopoulos, Mark Munsell, Munir Shahjahan, Naoto Ueno, Cindy Ippoliti, Borje S. Andersson, James Gajewski, Daniel Couriel, Jorge Cortes, Michele Donato, Joyce Neumann, Richard Champlin, and Sergio Giralt From the Departments of Blood and Marrow Transplantation, Leukemia, and Biostatistics, University of Texas MD Anderson Cancer Center, Houston. Intensity of the preparative regimen is an important component of allogeneic transplantations for myelodysplasia (MDS) or acute myelogenous leukemia (AML). We compared outcomes after a truly nonablative regimen (120 mg/m2 fludarabine, 4 g/m2 cytarabine, and 36 mg/m2 idarubicin [FAI]) and a more myelosuppressive, reduced-intensity regimen (100 to 150 mg/m2 fludarabine and 140 or 180 mg/m2 melphalan [FM]). We performed a retrospective analysis of 94 patients with MDS (n = 26) and AML (n = 68) treated with FM (n = 62) and FAI (n = 32). The FAI group had a higher proportion of patients in complete remission (CR) at transplantation (44% versus 16%, P = .006), patients in first CR (28% versus 3%, P = .008), and HLA-matched sibling donors (81% versus 40%, P = .001). Median follow-up is 40 months. FM was significantly associated with a higher degree of donor cell engraftment, higher cumulative incidence of treatment-related mortality (TRM; P = .036), and lower cumulative incidence of relapse-related mortality (P = .029). Relapse rate after FAI and FM was 61% and 30%, respectively. Actuarial 3-year survival rate was 30% after FAI and 35% following FM. In a multivariate analysis of patient- and treatment-related prognostic factors, progression-free survival was improved after FM, for patients in CR at transplantation, and for those with intermediate-risk cytogenetics. Survival was improved for patients in CR at transplantation. In conclusion, FM provided better disease control though at a cost of increased TRM and morbidity. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? Related Article in Blood Online: Fludarabine finds its significant other? John Barrett Blood 2004 104: 603-604. 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Sustained Remissions of High-Risk Acute Myeloid Leukemia and Myelodysplastic Syndrome After Reduced-Intensity Conditioning Allogeneic Hematopoietic Transplantation: Chronic Graft-Versus-Host Disease Is the Strongest Factor Improving Survival J. Clin. Oncol., February 1, 2008; 26(4): 577 - 584. [Abstract] [Full Text] [PDF] P. Anderlini, R. Saliba, S. Acholonu, S. A. Giralt, B. Andersson, N. T. Ueno, C. Hosing, I. F. Khouri, D. Couriel, M. de Lima, et al. Fludarabine-melphalan as a preparative regimen for reduced-intensity conditioning allogeneic stem cell transplantation in relapsed and refractory Hodgkin's lymphoma: the updated M.D. Anderson Cancer Center experience Haematologica, February 1, 2008; 93(2): 257 - 264. [Abstract] [Full Text] [PDF] P. Kebriaei, M. A. Detry, S. Giralt, A. Carrasco-Yalan, A. Anagnostopoulos, D. Couriel, I. F. Khouri, P. Anderlini, C. Hosing, A. Alousi, et al. Long-term follow-up of allogeneic hematopoietic stem-cell transplantation with reduced-intensity conditioning for patients with chronic myeloid leukemia Blood, November 1, 2007; 110(9): 3456 - 3462. [Abstract] [Full Text] [PDF] M. L. Sorror, B. M. Sandmaier, B. E. Storer, M. B. Maris, F. Baron, D. G. Maloney, B. L. Scott, H. J. Deeg, F. R. Appelbaum, and R. Storb Comorbidity and Disease Status Based Risk Stratification of Outcomes Among Patients With Acute Myeloid Leukemia or Myelodysplasia Receiving Allogeneic Hematopoietic Cell Transplantation J. Clin. Oncol., September 20, 2007; 25(27): 4246 - 4254. [Abstract] [Full Text] [PDF] D. Blaise, N. Vey, C. Faucher, and M. Mohty Current status of reduced intensity conditioning allogeneic stem cell transplantation for acute myeloid leukemia Haematologica, April 1, 2007; 92(4): 533 - 541. [Abstract] [Full Text] [PDF] E. Estey, M. de Lima, R. Tibes, S. Pierce, H. Kantarjian, R. Champlin, and S. 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Allogeneic Stem-Cell Transplantation Using a Reduced-Intensity Conditioning Regimen Has the Capacity to Produce Durable Remissions and Long-Term Disease-Free Survival in Patients With High-Risk Acute Myeloid Leukemia and Myelodysplasia J. Clin. Oncol., December 20, 2005; 23(36): 9387 - 9393. [Abstract] [Full Text] [PDF] M. de Lima, S. Giralt, Z. Caldera, G. McCormick, M. Qazilbash, P. Anderlini, E. J. Shpall, C. Hosing, M. Donato, S. Kornblau, et al. Results of a Phase I/II Study of Gemtuzumab Ozogamicin Added to Fludarabine (F), Melphalan (M) and Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) for Relapsed Myeloid Leukemias. Blood (ASH Annual Meeting Abstracts), November 16, 2005; 106(11): 841 - 841. [Abstract] M. Stelljes, M. Bornhauser, M. Kroger, J. Beyer, M. C. Sauerland, A. Heinecke, B. Berning, C. Scheffold, G. Silling, T. Buchner, et al. 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