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Graft-Versus-Host Disease

Intensive graft-versus-host disease prophylaxis is required after unrelated-donor nonmyeloablative stem cell transplantation

Bone Marrow Transplantation volume 35, pages 921–926 (2005)Cite this article

Summary:

Nonmyeloablative stem cell transplantation (NST) harnesses the graft-versus-tumor effect while minimizing regimen-related toxicity, and can result in donor chimerism and remission. Acute graft-versus-host disease (GVHD) and infections are major complications after sibling NST. Toxicity of unrelated-donor (UD) NST and the most appropriate GVHD prophylaxis in this setting remain poorly defined. We describe 25 patients who received UD-NST conditioned with fludarabine and cyclophosphamide. The first six patients received cyclosporine (Cs) and mycophenolate mofetil (MMF) (n=5) or methotrexate (MTX) (n=1) as GVHD prophylaxis (group 1) and all developed grade III–IV acute GVHD. The next 19 patients received the same conditioning regimen with the addition of alemtuzumab, and all received Cs/MTX post-transplant. Engraftment and donor chimerism were achieved in all but one evaluable patient. In all, 15 patients died: five of six deaths in group 1 were attributable to acute GVHD, while deaths in group 2 were due to infection or progressive disease (P=0.05). The combination of Cs/MMF is inadequate GVHD prophylaxis for UD-NST. The use of Cs, MTX, and alemtuzumab eliminated severe acute GVHD; its impact on response merits further study.

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Acknowledgements

We thank Anita McAlee and Kimberly Hummel for assistance with data collection, and Joan Waterbury for nursing support. This work was supported in part by a grant from the American Cancer Society CRTG-00-089-01-LBC (DLP). Results were presented in part at the American Society of Clinical Oncology Annual Meeting, Chicago, IL, 2003.

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Authors and Affiliations

  1. Bone Marrow and Stem Cell Transplant Programs, University of Pennsylvania Cancer Center, Philadelphia, PA, USA

    A W Loren, S M Luger, E A Stadtmauer, D E Tsai, S Schuster, S D Nasta, S C Goldstein, A Perl, J C Oliver, J Green, S G Emerson & D L Porter

  2. Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    A W Loren

  3. Fairfax-Inova Hospital, Fairfax, VA, USA

    G Orloff

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  1. A W Loren
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Correspondence to A W Loren.

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Loren, A., Luger, S., Stadtmauer, E. et al. Intensive graft-versus-host disease prophylaxis is required after unrelated-donor nonmyeloablative stem cell transplantation. Bone Marrow Transplant 35, 921–926 (2005). https://doi.org/10.1038/sj.bmt.1704887

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