|
|
Blood, 15 February 2005, Vol. 105, No. 4, pp. 1810-1814.
Prepublished online as a Blood First Edition Paper on September 30, 2004; DOI 10.1182/blood-2004-05-1947.
 Previous Article | Table of Contents | Next Article 
TRANSPLANTATION
Comparative outcome of nonmyeloablative and myeloablative allogeneic hematopoietic cell transplantation for patients older than 50 years of age
Edwin P. Alyea,
Haesook T. Kim,
Vincent Ho,
Corey Cutler,
John Gribben,
Daniel J. DeAngelo,
Stephanie J. Lee,
Sarah Windawi,
Jerome Ritz,
Richard M. Stone,
Joseph H. Antin, and
Robert J. Soiffer
From the Departments of Medical Oncology and Biostatistical Science, Dana-Farber Cancer Institute, Boston, MA; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Nonmyeloablative stem cell transplantation (NST) is increasingly used in older patients. The impact of the shift from myeloablative transplantation to NST on relapse, transplant complications, and outcome has yet to be fully examined. We performed a retrospective analysis of 152 patients older than 50 years undergoing NST or myeloablative transplantation. Seventy-one patients received nonmyeloablative conditioning, fludarabine (30 mg/m2/d x 4) and intravenous busulfan (0.8 mg/kg/d x 4); 81 patients received myeloablative conditioning, primarily cyclophosphamide and total body irradiation. NST patients were more likely to have unrelated donors (58% versus 36%; P = .009), a prior transplant (25% versus 4%; P = < .0001), and active disease at transplantation (85% versus 59%; P = < .001). Despite the adverse characteristics, overall survival was improved in the NST group at 1 year (51% versus 39%) and 2 years (39% versus 29%; P = .056). There was no difference in progression-free survival (2 years, 27% versus 25%; P = .24). The incidence of grade 2 to 4 graft-versus-host disease was similar (28% versus 27%). The nonrelapse mortality rate was lower for NST patients (32% versus 50%; P = .01), but the relapse rate was higher (46% versus 30%; P = .052). Our experience suggests that, in patients over age 50, NST with fludarabine and low-dose busulfan leads to an overall outcome at least as good as that following myeloablative therapy. (Blood. 2005;105:1810-1814)
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati What's this?
This article has been cited by other articles:
|
|
|
|
 
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]
|
|
|
|
|
|
|
F. M. Marty, J. Bryar, S. K. Browne, T. Schwarzberg, V. T. Ho, I. V. Bassett, J. Koreth, E. P. Alyea, R. J. Soiffer, C. S. Cutler, et al.
Sirolimus-based graft-versus-host disease prophylaxis protects against cytomegalovirus reactivation after allogeneic hematopoietic stem cell transplantation: a cohort analysis
Blood,
July 15, 2007;
110(2):
490 - 500.
[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]
|
|
|
|
|
|
|
C. Cutler, S. Li, V. T. Ho, J. Koreth, E. Alyea, R. J. Soiffer, and J. H. Antin
Extended follow-up of methotrexate-free immunosuppression using sirolimus and tacrolimus in related and unrelated donor peripheral blood stem cell transplantation
Blood,
April 1, 2007;
109(7):
3108 - 3114.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. T. Kim
Cumulative Incidence in Competing Risks Data and Competing Risks Regression Analysis
Clin. Cancer Res.,
January 15, 2007;
13(2):
559 - 565.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N.-C. Gorin, M. Labopin, J.-M. Boiron, N. Theorin, T. Littlewood, S. Slavin, H. Greinix, J. Y. Cahn, E. P. Alessandrino, A. Rambaldi, et al.
Results of Genoidentical Hemopoietic Stem Cell Transplantation With Reduced Intensity Conditioning for Acute Myelocytic Leukemia: Higher Doses of Stem Cells Infused Benefit Patients Receiving Transplants in Second Remission or Beyond--The Acute Leukemia Working Party of the European Cooperative Group for Blood and Marrow Transplantation
J. Clin. Oncol.,
August 20, 2006;
24(24):
3959 - 3966.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. L. Porter
RIC for MDS: the glass is half full
Blood,
August 1, 2006;
108(3):
780 - 781.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. S. Farag, K. J. Archer, K. Mrozek, A. S. Ruppert, A. J. Carroll, J. W. Vardiman, M. J. Pettenati, M. R. Baer, M. B. Qumsiyeh, P. R. Koduru, et al.
Pretreatment cytogenetics add to other prognostic factors predicting complete remission and long-term outcome in patients 60 years of age or older with acute myeloid leukemia: results from Cancer and Leukemia Group B 8461
Blood,
July 1, 2006;
108(1):
63 - 73.
[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]
|
|
|
|
|
|
|
C. J. Wu, L. Krishnamurti, J. L. Kutok, M. Biernacki, S. Rogers, W. Zhang, J. H. Antin, and J. Ritz
Evidence for ineffective erythropoiesis in severe sickle cell disease
Blood,
November 15, 2005;
106(10):
3639 - 3645.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. J. Deeg
Optimization of Transplant Regimens for Patients with Myelodysplastic Syndrome (MDS)
Hematology,
January 1, 2005;
2005(1):
167 - 173.
[Abstract]
[Full Text]
[PDF]
|
|
|
| |
