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Blood, 15 March 2005, Vol. 105, No. 6, pp. 2614. This Article Full Text (PDF) 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 CrossRef Citing Articles via Google Scholar Google Scholar Articles by Sorror, M. Articles by Storb, R. Search for Related Content PubMed PubMed Citation Articles by Sorror, M. Articles by Storb, R. Related Collections Related Article in Blood Online Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  CORRESPONDENCE To the editor: Lessened severe graft-versus-host after "minitransplantations" We greatly appreciate Dr Brian Abbott's commentary1 on the publication by Diaconescu et al,2 which compared toxicities and non-relapse mortality in patients undergoing HLA-matched related hematopoietic cell transplantation (HCT) following either nonablative or ablative conditioning, and we would like to make 3 points in response to his cautionary notes. First, we recently published very similar observations in patients given unrelated HCT.3 All nonablative patients in that study received 2 Gy total body irradiation preceded by 3 doses of fludarabine, 30 mg/m2/d for 3 days. Even though nonablative patients had significantly higher pretransplantation comorbidity scores, were older, and had more often failed preceding ablative HCT and cytotoxic chemotherapies, they experienced fewer grades III-IV toxicities than ablative patients. The 1-year nonrelapse mortality was 20% in nonablative compared with 32% in ablative patients, a difference that was significant after adjusting for pretransplantation differences between the 2 groups of patients (P = .04). Second, while we agree that no long-term follow-up data on disease control are available as yet, early results in patients with multiple myeloma, non-Hodgkin lymphoma, chronic lymphocytic leukemia, and acute myelocytic leukemia look encouraging.4-7 Third, the graft-versus-host disease (GVHD) incidence among nonablative recipients was lower than that among their ablative counterparts,3,8 and this was most pronounced for grades III-IV acute GVHD among unrelated recipients (Figure 1). View larger version (17K): [in this window] [in a new window]   Figure 1.. Grades III-IV acute GVHD in concurrent groups of nonablative and ablative patients given unrelated HCT (P = .01). Solid line indicates nonablative patients; broken line, ablative patients.   Finally, we share Dr Abbott's enthusiasm for the use of the Charlson Comorbidity Index (CCI) to evaluate patients before HCT. Patients with CCI scores of 1 or higher might benefit from undergoing nonablative HCT, regardless of their age. Mohamed Sorror, Michael Maris, Razvan Diaconescu, and Rainer Storb Correspondence: Rainer Storb, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave North, D1-100, PO Box 19024, Seattle, WA 98109-1024; e-mail: rstorb{at}fhcrc.org. References Abbott BL. Do "minitransplantations" have "minitoxicity"? Blood. 2004;104: 1239-1240.[Free Full Text] Diaconescu R, Flowers CR, Storer B, et al. Morbidity and mortality with nonmyeloablative compared to myeloablative conditioning before hematopoietic cell transplantation from HLA matched related donors. Blood. 2004;104: 1550-1558.[Abstract/Free Full Text] Sorror ML, Maris MB, Storer B, et al. Comparing morbidity and mortality of HLA-matched unrelated donor hematopoietic cell transplantation after nonmyeloablative and myeloablative conditioning: influence of pretransplant comorbidities. Blood. 2004;104: 961-968.[Abstract/Free Full Text] Sorror ML, Maris MB, Sandmaier BM, et al. Treatment of patients (PTS) with chemotherapy-refractory chronic lymphocytic leukemia (CLL) with nonmyeloablative (NM) conditioning and hematopoietic cell transplantation (HCT) from HLA-matched related (MRD) or unrelated donors (URD) [abstract]. Biol Blood Marrow Transplant. 2004;10: 26. Maris MB, Sandmaier BM, Storer BE, et al. Allogeneic hematopoietic cell transplantation after fludarabine and 2 Gy total body irradiation for relapsed and refractory mantle cell lymphoma. Blood. 2004;104: 3535-3542.[Abstract/Free Full Text] Maloney DG, Molina AJ, Sahebi F, et al. Allografting with nonmyeloablative conditioning following cytoreductive autografts for the treatment of patients with multiple myeloma. Blood. 2003;102: 3447-3454.[Abstract/Free Full Text] Feinstein LC, Sandmaier BM, Hegenbart U, et al. Non-myeloablative allografting from human leucocyte antigen-identical sibling donors for treatment of acute myeloid leukaemia in first complete remission. Br J Haematol. 2003;120: 281-288.[CrossRef][Medline] [Order article via Infotrieve] Mielcarek M, Martin PJ, Leisenring W, et al. Graft-versus-host disease after nonmyeloablative versus conventional hematopoietic stem cell transplantation. Blood. 2003;102: 756-762.[Abstract/Free Full Text] 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 Full Text (PDF) 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 CrossRef Citing Articles via Google Scholar Google Scholar Articles by Sorror, M. Articles by Storb, R. Search for Related Content PubMed PubMed Citation Articles by Sorror, M. Articles by Storb, R. Related Collections Related Article in Blood Online Social Bookmarking                   What's this?

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