Safety and outcome after fludarabine-thiotepa-TBI conditioning for allogeneic transplantation: A prospective study of 30 patients with hematologic malignancies

K. van Besien, S. Devine, A. Wickrema, E. Jessop, K. Amin, M. Yassine, V. Maynard, W. Stock, D. Peace, F. Ravandi, Y. H. Chen, T. Cheung, S. Vijayakumar, R. Hoffman, J. Sosman

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Fludarabine, thiotepa and total body irradiation (TBI) has been used as conditioning in haplo-identical transplantation. We studied this conditioning regimen in adults undergoing matched sibling transplantation and alternative donor transplantation. A total of 30 consecutive patients underwent matched related, haplo-identical related or matched unrelated donor transplantation with fludarabine, thiotepa and TBI conditioning. All but four had advanced hematologic malignancies. For haplo-identical transplant, ATG was added to the regimen. All patients received peripheral blood stem cells; these were T-cell depleted for 2-antigen or 3-antigen mismatched related transplantation. Additional graft-versus-host disease prophylaxis consisted of tacrolimus and mini-methotrexate. One recipient of haplo-identical transplant failed to engraft; all other evaluable patients had prompt engraftment. Four patients died of regimen-related toxicity. In all, 14 additional patients died of regimen-related causes including four from failure to thrive with persistent thrombocytopenia and four from delayed pulmonary toxicity. Six patients relapsed. Progression-free survival at 12 months was 47% (90% CI: 25-69%) for recipients of HLA-identical sibling transplants and 30% (90% CI: 14-46%) for all patients. Five of six long-term survivors have extensive chronic GVHD. As a result of the delayed complications and a relatively high recurrence rate, we abandoned this regimen.

Original languageEnglish
Pages (from-to)9-13
Number of pages5
JournalBone Marrow Transplantation
Volume32
Issue number1
DOIs
StatePublished - Jul 2003
Externally publishedYes

Keywords

  • Fludarabine
  • TBI
  • Thiotepa
  • Toxicity
  • Transplatation

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