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Blood, 15 August 2004, Vol. 104, No. 4, pp. 961-968.
Prepublished online as a Blood First Edition Paper on April 27, 2004; DOI 10.1182/blood-2004-02-0545.
 Previous Article | Next Article 
Submitted February 12, 2004
Accepted April 8, 2004
Comparing Morbidity and Mortality of HLA-Matched Unrelated Donor Hematopoietic Cell Transplantation after Nonmyeloablative and Myeloablative Conditioning: Influence of Pretransplant Comorbidities
Mohamed L Sorror, Michael B Maris, Barry Storer, Brenda M Sandmaier, Razvan Diaconescu, Christopher Flowers, David G Maloney, and Rainer Storb*
Fred Hutchinson Cancer Research Center, Seattle, WA, USA
Fred Hutchinson Cancer Research Center, Seattle, WA, USA; University of Washington, Seattle, WA, USA
* Corresponding author; email: rstorb{at}fhcrc.org, hcrawfor@fhcrc.org.
We have carried out HLA-matched unrelated donor hematopoietic cell transplantation (HCT) after nonmyeloablative conditioning in patients with hematological malignancies who were ineligible for conventional transplants because of age and/or comorbidities. The nonmyeloablative regimen consisted of 90 mg/m2 fludarabine and 2 Gy total body irradiation given before and mycophenolate mofetil and cyclosporine given after HCT. This report compares, retrospectively, morbidity and mortality among 60 consecutive patients given nonmyeloablative conditioning (nonablative patients) to those among 74 concurrent and consecutive patients given myeloablative conditioning (ablative patients) before unrelated HCT. The Charlson Comorbidity Index was used to assess pretransplant comorbidities. Even though nonablative patients had significantly higher pretransplant comorbidity scores, were older, and had more often failed preceding ablative transplants and cytotoxic therapies, they experienced less grade III-IV toxicities than ablative patients. Further, the incidence of grade III-IV acute GVHD was significantly lower in nonablative patients. Both patient groups had comparable 1-year probabilities of chronic GVHD. The 1-year non-relapse mortality was 20% in nonablative compared to 32% in ablative patients (hazard ratio=1.4). After adjustment for pretransplant differences between the two patient groups, the hazard ratio was 3.0 (P=0.04). Multivariate analyses showed higher pretransplant comorbidity scores to result in increased toxicity and mortality.
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