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Blood, 1 February 2002, Vol. 99, No. 3, pp. 1071-1078
TRANSPLANTATION
Limiting transplantation-related mortality following unrelated
donor stem cell transplantation by using a nonmyeloablative
conditioning regimen
Ronjon Chakraverty,
Karl Peggs,
Rajesh Chopra,
Donald W. Milligan,
Panagiotis
D. Kottaridis,
Stephanie Verfuerth,
Johanne Geary,
Dharsha Thuraisundaram,
Kate Branson,
Suparno Chakrabarti,
Premini Mahendra,
Charles Craddock,
Anne Parker,
Ann Hunter,
Geoff Hale,
Herman Waldmann,
Catherine D. Williams,
Kwee Yong,
David C. Linch,
Anthony H. Goldstone, and
Stephen Mackinnon
From the Departments of Haematology, University College
London Hospital, United Kingdom; University Hospital Birmingham and
Heartlands Hospital Birmingham, United Kingdom; Christie Hospital
Manchester, United Kingdom; Glasgow Royal Infirmary, United Kingdom;
Leicester Royal Infirmary, United Kingdom; and Sir William Dunn School
of Pathology, University of Oxford; United Kingdom.
A nonmyeloablative conditioning regimen was investigated in
47 patients with hematological malignancy receiving allogeneic progenitor cells from matched, unrelated donors. The median
patient age was 44 years. The majority of patients had high-risk
features, including having failed a prior transplantation (29 individuals). Twenty of the transplants were mismatched for HLA class
I and/or class II alleles. Recipient conditioning consisted of
20 mg CAMPATH-1H on days  8 to 4, 30 mg/m2
fludarabine on days 7 to 3, and 140 mg/m2 melphalan on
day 2. Graft-versus-host disease (GVHD) prophylaxis was with
cyclosporine A alone. Primary graft failure occurred in only 2 of 44 evaluable patients (4.5%). Chimerism studies in 34 patients indicated
that the majority (85.3%) attained initial full donor chimerism. Only
3 patients developed grade III to IV acute GVHD, and no patients have
yet developed chronic extensive GVHD. The estimated probability of
nonrelapse mortality at day 100 was 14.9% (95% confidence interval
[CI], 4.7%-25.1%). With a median follow-up of 344 days (range,
79-830), overall and progression-free survivals at 1 year were 75.5%
(95% CI, 62.8%-88.2%) and 61.5% (95% CI, 46.1%-76.8%),
respectively. In summary, a nonmyeloablative regimen incorporating in
vivo CAMPATH-1H is effective in promoting durable engraftment in most
patients and in reducing the risk of severe GVHD following matched
unrelated donor transplantation.
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Related Letter in Blood Online:
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Nonmyeloablative transplantation challenged by experimentation
- Marlies E. H. M. Van Hoef ; and Stephen Mackinnon
Blood 2002 100: 1508-1509.
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