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Blood, 1 September 2004, Vol. 104, No. 5, pp. 1550-1558. Prepublished online as a Blood First Edition Paper on May 18, 2004; DOI 10.1182/blood-2004-03-0804. This Article Full Text Full Text (PDF) All Versions of this Article: 2004-03-0804v1 104/5/1550    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 Diaconescu, R. Articles by Storb, R. Search for Related Content PubMed PubMed Citation Articles by Diaconescu, R. Articles by Storb, R. Related Collections Transplantation Clinical Trials and Observations Neoplasia Related Article in Blood Online Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  TRANSPLANTATION Morbidity and mortality with nonmyeloablative compared with myeloablative conditioning before hematopoietic cell transplantation from HLA-matched related donors Razvan Diaconescu, Christopher R. Flowers, Barry Storer, Mohamed L. Sorror, Michael B. Maris, David G. Maloney, Brenda M. Sandmaier, and Rainer Storb From the Fred Hutchinson Cancer Research Center, Seattle, WA; and the University of Washington School of Medicine, Seattle. Nonmyeloablative regimens for allogeneic hematopoietic cell transplantation (HCT) have been developed for patients ineligible for myeloablative conditioning. We compared regimen-related toxicities (RRTs) and nonrelapse mortality (NRM) in 73 nonmyeloablative and 73 myeloablative recipients of HLA-matched related donor HCT, using the National Cancer Institute (NCI) Common Toxicity Criteria. Nonmyeloablative regimens were 2 Gy total body irradiation (TBI), either alone (n = 40) or combined with fludarabine, 30 mg/m2/d for 3 days (n = 33). Posttransplantation immunosuppression included mycophenolate mofetil and cyclosporine. Myeloablative regimens consisted mostly of cyclophosphamide + TBI or busulfan + cyclophosphamide, followed by posttransplantation methotrexate and cyclosporine. Nonmyeloablative patients were at higher risk than ablative patients because of greater age, longer time from diagnosis to HCT, more frequent preceding high-dose HCT, and higher pretransplantation Charlson comorbidity scores. Nevertheless, they experienced significantly less severe toxicities in 7 organs/systems: hematologic, gastrointestinal, hepatic, hemorrhage, infection, metabolic, and pulmonary. This translated into less NRM at day 100 (3% versus 23%, P = 10-4) and 1 year (16% versus 30%, P = .04). In multivariate analysis, the strongest factor predicting lessened RRT and NRM was nonmyeloablative conditioning, whereas high pretransplantation comorbidity scores predicted higher NRM. In conclusion, nonmyeloablative regimens had lower RRT and NRM and could be considered for comparative studies, including younger patients with more favorable Charlson comorbidity scores. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? Related Article in Blood Online: Do "minitransplantations" have "minitoxicity"? Brian L. Abbott Blood 2004 104: 1239-1240. [Full Text] [PDF] This article has been cited by other articles: M. R. Baer, H. D. Klepin, and A. S. 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Schuening, S. Rowley, D. David, M. Brunvand, B. Berryman, S. Abhyankar, et al. A randomized, placebo-controlled trial of oral beclomethasone dipropionate as a prednisone-sparing therapy for gastrointestinal graft-versus-host disease Blood, May 15, 2007; 109(10): 4557 - 4563. [Abstract] [Full Text] [PDF] E. Estey, M. de Lima, R. Tibes, S. Pierce, H. Kantarjian, R. Champlin, and S. Giralt Prospective feasibility analysis of reduced-intensity conditioning (RIC) regimens for hematopoietic stem cell transplantation (HSCT) in elderly patients with acute myeloid leukemia (AML) and high-risk myelodysplastic syndrome (MDS) Blood, February 15, 2007; 109(4): 1395 - 1400. [Abstract] [Full Text] [PDF] R. Martino, R. Parody, T. Fukuda, J. Maertens, K. Theunissen, A. Ho, G. J. Mufti, N. Kroger, A. R. Zander, D. Heim, et al. Impact of the intensity of the pretransplantation conditioning regimen in patients with prior invasive aspergillosis undergoing allogeneic hematopoietic stem cell transplantation: a retrospective survey of the Infectious Diseases Working Party of the European Group for Blood and Marrow Transplantation Blood, November 1, 2006; 108(9): 2928 - 2936. [Abstract] [Full Text] [PDF] C. Schmid, M. Schleuning, R. Schwerdtfeger, B. Hertenstein, E. Mischak-Weissinger, D. Bunjes, S. v. Harsdorf, C. Scheid, U. Holtick, H. Greinix, et al. Long-term survival in refractory acute myeloid leukemia after sequential treatment with chemotherapy and reduced-intensity conditioning for allogeneic stem cell transplantation Blood, August 1, 2006; 108(3): 1092 - 1099. [Abstract] [Full Text] [PDF] S. O. Schonland, H. Lokhorst, A. Buzyn, V. Leblond, U. Hegenbart, G. Bandini, A. Campbell, E. Carreras, A. Ferrant, L. Grommisch, et al. Allogeneic and syngeneic hematopoietic cell transplantation in patients with amyloid light-chain amyloidosis: a report from the European Group for Blood and Marrow Transplantation Blood, March 15, 2006; 107(6): 2578 - 2584. [Abstract] [Full Text] [PDF] U. Hegenbart, D. Niederwieser, B. M. Sandmaier, M. B. Maris, J. A. Shizuru, H. Greinix, C. Cordonnier, B. Rio, A. Gratwohl, T. Lange, et al. Treatment for Acute Myelogenous Leukemia by Low-Dose, Total-Body, Irradiation-Based Conditioning and Hematopoietic Cell Transplantation From Related and Unrelated Donors J. Clin. Oncol., January 20, 2006; 24(3): 444 - 453. [Abstract] [Full Text] [PDF] B. L. Scott and B. M. Sandmaier Outcomes with Myeloid Malignancies Hematology, January 1, 2006; 2006(1): 381 - 389. [Abstract] [Full Text] [PDF] F. Locatelli Reduced-Intensity Regimens in Allogeneic Hematopoietic Stem Cell Transplantation for Hemoglobinopathies Hematology, January 1, 2006; 2006(1): 398 - 401. [Abstract] [Full Text] [PDF] E. Ayala, M. 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Mielcarek, et al. Graft-Versus-Tumor Effects After Allogeneic Hematopoietic Cell Transplantation With Nonmyeloablative Conditioning J. Clin. Oncol., March 20, 2005; 23(9): 1993 - 2003. [Abstract] [Full Text] [PDF] M. Sorror, M. Maris, R. Diaconescu, and R. Storb Lessened severe graft-versus-host after "minitransplantations" Blood, March 15, 2005; 105(6): 2614 - 2614. [Full Text] [PDF] J. J. Cornelissen and B. Lowenberg Role of Allogeneic Stem Cell Transplantation in Current Treatment of Acute Myeloid Leukemia Hematology, January 1, 2005; 2005(1): 151 - 155. [Abstract] [Full Text] [PDF] S. Giralt Reduced-Intensity Conditioning Regimens for Hematologic Malignancies: What Have We Learned over the Last 10 Years? Hematology, January 1, 2005; 2005(1): 384 - 389. [Abstract] [Full Text] [PDF] M. B. Maris, B. M. Sandmaier, B. E. Storer, T. Chauncey, M. J. Stuart, R. T. Maziarz, E. Agura, A. A. Langston, M. Pulsipher, R. Storb, et al. Allogeneic hematopoietic cell transplantation after fludarabine and 2 Gy total body irradiation for relapsed and refractory mantle cell lymphoma Blood, December 1, 2004; 104(12): 3535 - 3542. [Abstract] [Full Text] [PDF]

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