Blood online
Home About Blood Authors Subscriptions Permission Advertising Public Access contact us
 

 
Advanced
Current Issue
First Edition
Archives
Submit to Blood
Search
American Society of Hematology
Meeting Abstracts
Email Alerts
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Right arrow Rights and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Giralt, S.
Right arrow Articles by Champlin, R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Giralt, S.
Right arrow Articles by Champlin, R.
Related Collections
Right arrow Neoplasia
Right arrow Transplantation
Right arrow Clinical Trials and Observations
Social Bookmarking
 Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?

arrow to previous article Previous Article  |  Table of Contents  |  Next Article next article arrow

Blood, 1 February 2001, Vol. 97, No. 3, pp. 631-637

CLINICAL OBSERVATONS, INTERVENTIONS, AND THERAPEUTIC TRIALS

Melphalan and purine analog-containing preparative regimens: reduced-intensity conditioning for patients with hematologic malignancies undergoing allogeneic progenitor cell transplantation

Sergio Giralt, Peter F. Thall, Issa Khouri, Xuemei Wang, Ira Braunschweig, Cindy Ippolitti, David Claxton, Michele Donato, Jill Bruton, Agueda Cohen, Marilyn Davis, Borje S. Andersson, Paolo Anderlini, James Gajewski, Steven Kornblau, Michael Andreeff, Donna Przepiorka, Naoto T. Ueno, Jeff Molldrem, and Richard Champlin

From the Department of Blood and Bone Marrow Transplantation and Biomathematics, University of Texas MD Anderson Cancer Center, Houston, TX.

A reduced-intensity preparative regimen consisting of melphalan and a purine analog was evaluated for allogeneic transplantation in 86 patients who had a variety of hematologic malignancies and were considered poor candidates for conventional myeloablative therapies because of age or comorbidity. Seventy-eight patients received fludarabine 25 mg/m2 daily for 5 days in combination with melphalan 180 mg/m2 (n = 66) or 140 mg/m2 (n = 12). Eight patients received cladribine 12 mg/m2 continuous infusion for 5 days with melphalan 180 mg/m2. The median age was 52 years (range, 22-70 years). Disease status at transplantation was either first remission or first chronic phase in 7 patients, untreated first relapse or subsequent remission in 16 patients, and refractory leukemia or transformed chronic myelogenous leukemia in 63 patients. Nonrelapse mortality rates on day 100 were 37.4% for the fludarabine/melphalan combination and 87.5% for the cladribine/melphalan combination. The median percentage of donor cells at 1 month in 75 patients was 100% (range, 0%-100%). The probability of grade 2-4 and 3-4 acute graft-versus-host disease was 0.49 (95% CI, 0.38-0.60) and 0.29 (95% CI, 0.18-0.41), respectively. Disease-free survival at 1 year was 57% for patients in first remission or chronic phase and 49% for patients with untreated first relapse or in a second or later remission. On multivariate analysis the strongest predictor for disease-free survival was a good or intermediate risk category. In summary, fludarabine/melphalan combinations are feasible in older patients with associated comorbidities, and long-term disease control can be achieved with reduced-intensity conditioning in this population.

© 2001 by The American Society of Hematology.
 

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?


This article has been cited by other articles:


Home page
haematolHome page
F. Ayuk, J. A. Perez-Simon, A. Shimoni, A. Sureda, T. Zabelina, R. Schwerdtfeger, R. Martino, H. G. Sayer, A. Alegre, J.-J. Lahuerta, et al.
Clinical impact of human Jurkat T-cell-line-derived antithymocyte globulin in multiple myeloma patients undergoing allogeneic stem cell transplantation
Haematologica, September 1, 2008; 93(9): 1343 - 1350.
[Abstract] [Full Text] [PDF]


Home page
BloodHome page
R. Marks, K. Potthoff, J. Hahn, G. Ihorst, H. Bertz, A. Spyridonidis, E. Holler, and J. M. Finke
Reduced-toxicity conditioning with fludarabine, BCNU, and melphalan in allogeneic hematopoietic cell transplantation: particular activity against advanced hematologic malignancies
Blood, July 15, 2008; 112(2): 415 - 425.
[Abstract] [Full Text] [PDF]


Home page
JCOHome page
H. M. Lazarus, G. L. Phillips, R. H. Herzig, D. D. Hurd, S. N. Wolff, and G. P. Herzig
High-Dose Melphalan and the Development of Hematopoietic Stem-Cell Transplantation: 25 Years Later
J. Clin. Oncol., May 10, 2008; 26(14): 2240 - 2243.
[Full Text] [PDF]


Home page
BloodHome page
A. A. Jakubowski, T. N. Small, J. W. Young, N. A. Kernan, H. Castro-Malaspina, K. C. Hsu, M.-A. Perales, N. Collins, C. Cisek, M. Chiu, et al.
T cell depleted stem-cell transplantation for adults with hematologic malignancies: sustained engraftment of HLA-matched related donor grafts without the use of antithymocyte globulin
Blood, December 15, 2007; 110(13): 4552 - 4559.
[Abstract] [Full Text] [PDF]


Home page
BloodHome page
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]


Home page
BloodHome page
C. G. Brunstein, J. N. Barker, D. J. Weisdorf, T. E. DeFor, J. S. Miller, B. R. Blazar, P. B. McGlave, and J. E. Wagner
Umbilical cord blood transplantation after nonmyeloablative conditioning: impact on transplantation outcomes in 110 adults with hematologic disease
Blood, October 15, 2007; 110(8): 3064 - 3070.
[Abstract] [Full Text] [PDF]


Home page
Stem CellsHome page
Y.-G. Yao, R. W. Childs, S. Kajigaya, J. P. McCoy Jr., and N. S. Young
Mitochondrial DNA Sequence Heterogeneity of Single CD34+ Cells After Nonmyeloablative Allogeneic Stem Cell Transplantation
Stem Cells, October 1, 2007; 25(10): 2670 - 2676.
[Abstract] [Full Text] [PDF]


Home page
Ann OncolHome page
M Devetten and J. Armitage
Hematopoietic cell transplantation: progress and obstacles
Ann. Onc., September 1, 2007; 18(9): 1450 - 1456.
[Abstract] [Full Text] [PDF]


Home page
BloodHome page
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]


Home page
BloodHome page
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]


Home page
Stem CellsHome page
P. J. Shaughnessy, C. Bachier, C. F. LeMaistre, C. Akay, B. H. Pollock, and Y. Gazitt
Granulocyte Colony-Stimulating Factor Mobilizes More Dendritic Cell Subsets Than Granulocyte-Macrophage Colony-Stimulating Factor with No Polarization of Dendritic Cell Subsets in Normal Donors
Stem Cells, July 1, 2006; 24(7): 1789 - 1797.
[Abstract] [Full Text] [PDF]


Home page
BloodHome page
E. Montserrat, C. Moreno, J. Esteve, A. Urbano-Ispizua, E. Gine, and F. Bosch
How I treat refractory CLL
Blood, February 15, 2006; 107(4): 1276 - 1283.
[Abstract] [Full Text] [PDF]


Home page
JCOHome page
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]


Home page
JCOHome page
S. Tauro, C. Craddock, K. Peggs, G. Begum, P. Mahendra, G. Cook, J. Marsh, D. Milligan, A. Goldstone, A. Hunter, et al.
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]


Home page
NEJMHome page
R. Lowsky, T. Takahashi, Y. P. Liu, S. Dejbakhsh-Jones, F. C. Grumet, J. A. Shizuru, G. G. Laport, K. E. Stockerl-Goldstein, L. J. Johnston, R. T. Hoppe, et al.
Protective conditioning for acute graft-versus-host disease.
N. Engl. J. Med., September 29, 2005; 353(13): 1321 - 1331.
[Abstract] [Full Text] [PDF]


Home page
JCOHome page
A. Molina, J. Zain, D. A. Arber, M. Angelopolou, M. O'Donnell, J. Murata-Collins, S. J. Forman, and A. Nademanee
Durable Clinical, Cytogenetic, and Molecular Remissions After Allogeneic Hematopoietic Cell Transplantation for Refractory Sezary Syndrome and Mycosis Fungoides
J. Clin. Oncol., September 1, 2005; 23(25): 6163 - 6171.
[Abstract] [Full Text] [PDF]


Home page
JCOHome page
C. Schmid, M. Schleuning, G. Ledderose, J. Tischer, and H.-J. Kolb
Sequential Regimen of Chemotherapy, Reduced-Intensity Conditioning for Allogeneic Stem-Cell Transplantation, and Prophylactic Donor Lymphocyte Transfusion in High-Risk Acute Myeloid Leukemia and Myelodysplastic Syndrome
J. Clin. Oncol., August 20, 2005; 23(24): 5675 - 5687.
[Abstract] [Full Text] [PDF]


Home page
JCOHome page
K. van Besien, A. Artz, S. Smith, D. Cao, S. Rich, L. Godley, D. Jones, P. Del Cerro, D. Bennett, B. Casey, et al.
Fludarabine, Melphalan, and Alemtuzumab Conditioning in Adults With Standard-Risk Advanced Acute Myeloid Leukemia and Myelodysplastic Syndrome
J. Clin. Oncol., August 20, 2005; 23(24): 5728 - 5738.
[Abstract] [Full Text] [PDF]


Home page
BloodHome page
M. Girgis, C. Hallemeier, W. Blum, R. Brown, H.-s. Lin, H. Khoury, L. T. Goodnough, R. Vij, S. Devine, M. Wehde, et al.
Chimerism and clinical outcomes of 110 recipients of unrelated donor bone marrow transplants who underwent conditioning with low-dose, single-exposure total body irradiation and cyclophosphamide
Blood, April 15, 2005; 105(8): 3035 - 3041.
[Abstract] [Full Text] [PDF]


Home page
BloodHome page
T. M. Cao, J. A. Shizuru, R. M. Wong, K. Sheehan, G. G. Laport, K. E. Stockerl-Goldstein, L. J. Johnston, M. J. Stuart, F. C. Grumet, R. S. Negrin, et al.
Engraftment and survival following reduced-intensity allogeneic peripheral blood hematopoietic cell transplantation is affected by CD8+ T-cell dose
Blood, March 15, 2005; 105(6): 2300 - 2306.
[Abstract] [Full Text] [PDF]


Home page
ASH Education BookHome page
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]


Home page
J. Immunol.Home page
M. P. Rettig, J. K. Ritchey, J. L. Prior, J. S. Haug, D. Piwnica-Worms, and J. F. DiPersio
Kinetics of In Vivo Elimination of Suicide Gene-Expressing T Cells Affects Engraftment, Graft-versus-Host Disease, and Graft-versus-Leukemia after Allogeneic Bone Marrow Transplantation
J. Immunol., September 15, 2004; 173(6): 3620 - 3630.
[Abstract] [Full Text] [PDF]


Home page
BloodHome page
A. Y. L. Ho, A. Pagliuca, M. Kenyon, J. E. Parker, A. Mijovic, S. Devereux, and G. J. Mufti
Reduced-intensity allogeneic hematopoietic stem cell transplantation for myelodysplastic syndrome and acute myeloid leukemia with multilineage dysplasia using fludarabine, busulphan, and alemtuzumab (FBC) conditioning
Blood, September 15, 2004; 104(6): 1616 - 1623.
[Abstract] [Full Text] [PDF]


Home page
BloodHome page
R. Diaconescu, C. R. Flowers, B. Storer, M. L. Sorror, M. B. Maris, D. G. Maloney, B. M. Sandmaier, and R. Storb
Morbidity and mortality with nonmyeloablative compared with myeloablative conditioning before hematopoietic cell transplantation from HLA-matched related donors
Blood, September 1, 2004; 104(5): 1550 - 1558.
[Abstract] [Full Text] [PDF]


Home page
BloodHome page
M. L. Sorror, M. B. Maris, B. Storer, B. M. Sandmaier, R. Diaconescu, C. Flowers, D. G. Maloney, and R. Storb
Comparing morbidity and mortality of HLA-matched unrelated donor hematopoietic cell transplantation after nonmyeloablative and myeloablative conditioning: influence of pretransplantation comorbidities
Blood, August 15, 2004; 104(4): 961 - 968.
[Abstract] [Full Text] [PDF]


Home page
BloodHome page
M. de Lima, D. Couriel, P. F. Thall, X. Wang, T. Madden, R. Jones, E. J. Shpall, M. Shahjahan, B. Pierre, S. Giralt, et al.
Once-daily intravenous busulfan and fludarabine: clinical and pharmacokinetic results of a myeloablative, reduced-toxicity conditioning regimen for allogeneic stem cell transplantation in AML and MDS
Blood, August 1, 2004; 104(3): 857 - 864.
[Abstract] [Full Text] [PDF]


Home page
BloodHome page
M. de Lima, A. Anagnostopoulos, M. Munsell, M. Shahjahan, N. Ueno, C. Ippoliti, B. S. Andersson, J. Gajewski, D. Couriel, J. Cortes, et al.
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
Blood, August 1, 2004; 104(3): 865 - 872.
[Abstract] [Full Text] [PDF]


Home page
BloodHome page
K. V. Besien, S. Smith, J. Anastasi, R. Larson, M. Thirman, T. Odenike, and W. Stock
Irreversible myelosuppression after fludarabine-melphalan conditioning: observations in patients with graft rejection
Blood, June 1, 2004; 103(11): 4373 - 4374.
[Full Text] [PDF]


Home page
BloodHome page
C. Carvallo, N. Geller, R. Kurlander, R. Srinivasan, O. Mena, T. Igarashi, L. M. Griffith, W. M. Linehan, and R. W. Childs
Prior chemotherapy and allograft CD34+ dose impact donor engraftment following nonmyeloablative allogeneic stem cell transplantation in patients with solid tumors
Blood, February 15, 2004; 103(4): 1560 - 1563.
[Abstract] [Full Text] [PDF]


Home page
BloodHome page
J. Casper, W. Knauf, T. Kiefer, D. Wolff, B. Steiner, U. Hammer, R. Wegener, H.-D. Kleine, S. Wilhelm, A. Knopp, et al.
Treosulfan and fludarabine: a new toxicity-reduced conditioning regimen for allogeneic hematopoietic stem cell transplantation
Blood, January 15, 2004; 103(2): 725 - 731.
[Abstract] [Full Text] [PDF]


Home page
BloodHome page
B. Barlogie, J. Shaughnessy, G. Tricot, J. Jacobson, M. Zangari, E. Anaissie, R. Walker, and J. Crowley
Treatment of multiple myeloma
Blood, January 1, 2004; 103(1): 20 - 32.
[Abstract] [Full Text] [PDF]


Home page
BloodHome page
H. J. Deeg, T. A. Gooley, M. E. D. Flowers, G. E. Sale, J. T. Slattery, C. Anasetti, T. R. Chauncey, K. Doney, G. E. Georges, H.-P. Kiem, et al.
Allogeneic hematopoietic stem cell transplantation for myelofibrosis
Blood, December 1, 2003; 102(12): 3912 - 3918.
[Abstract] [Full Text] [PDF]


Home page
BloodHome page
N. T. Ueno, Y. C. Cheng, G. Rondon, N. M. Tannir, J. L. Gajewski, D. R. Couriel, C. Hosing, M. J. de Lima, P. Anderlini, I. F. Khouri, et al.
Rapid induction of complete donor chimerism by the use of a reduced-intensity conditioning regimen composed of fludarabine and melphalan in allogeneic stem cell transplantation for metastatic solid tumors
Blood, November 15, 2003; 102(10): 3829 - 3836.
[Abstract] [Full Text] [PDF]


Home page
BloodHome page
R. Wong, S. A. Giralt, T. Martin, D. R. Couriel, A. Anagnostopoulos, C. Hosing, B. S. Andersson, P. Cano, M. Shahjahan, C. Ippoliti, et al.
Reduced-intensity conditioning for unrelated donor hematopoietic stem cell transplantation as treatment for myeloid malignancies in patients older than 55 years
Blood, October 15, 2003; 102(8): 3052 - 3059.
[Abstract] [Full Text] [PDF]


Home page
NEJMHome page
J. M. Goldman and J. V. Melo
Chronic Myeloid Leukemia -- Advances in Biology and New Approaches to Treatment
N. Engl. J. Med., October 9, 2003; 349(15): 1451 - 1464.
[Full Text] [PDF]


Home page
BloodHome page
E. Bachar-Lustig, S. Reich-Zeliger, and Y. Reisner
Anti-third-party veto CTLs overcome rejection of hematopoietic allografts: synergism with rapamycin and BM cell dose
Blood, September 15, 2003; 102(6): 1943 - 1950.
[Abstract] [Full Text] [PDF]


Home page
BloodHome page
M. B. Maris, D. Niederwieser, B. M. Sandmaier, B. Storer, M. Stuart, D. Maloney, E. Petersdorf, P. McSweeney, M. Pulsipher, A. Woolfrey, et al.
HLA-matched unrelated donor hematopoietic cell transplantation after nonmyeloablative conditioning for patients with hematologic malignancies
Blood, September 15, 2003; 102(6): 2021 - 2030.
[Abstract] [Full Text] [PDF]