Salvage allogeneic hematopoietic cell transplantation with fludarabine and low-dose total body irradiation after rejection of first allografts

Biol Blood Marrow Transplant. 2009 Oct;15(10):1314-22. doi: 10.1016/j.bbmt.2009.06.011. Epub 2009 Aug 3.

Abstract

We summarized results in 38 consecutive patients (median age=56 years) with hematologic malignancies (n=35), aplastic anemia (n=2), or renal cell carcinoma (n=1), who underwent salvage hematopoietic cell transplantation (HCT) for allograft rejection. In 14 patients, the original donors were used for salvage HCT, and, in 24 cases, different donors were used. Conditioning for salvage HCT consisted of fludarabine (Flu) and either 3 or 4 Gy total body irradiation (TBI). Sustained engraftment was achieved in 33 patients (87%). Grafts were rejected in 5 patients (13%), 4 of whom had myelofibrosis. With a median follow-up of 2 years (range: 0.3 to 7.8 years), the 2- and 4-year estimated survivals were 49% and 42%, respectively. The 2-year relapse rate and nonrelapse mortality (NRM) were 36% and 24%, respectively. The 2-year cumulative incidences of grades II-IV acute and moderate-severe chronic graft-versus-host disease (aGVHD, cGVHD) were 42% and 41%, respectively. In this cohort, TBI dose, grafts from original versus different donors, related versus unrelated donors, and HCT comorbidity scores did not have an impact on outcomes. We concluded that graft rejection after allogeneic HCT could be overcome by salvage transplantation using conditioning with Flu and low-dose TBI.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Acute Disease
  • Adolescent
  • Adult
  • Aged
  • Anemia, Aplastic / mortality
  • Anemia, Aplastic / therapy
  • Child
  • Chronic Disease
  • Female
  • Follow-Up Studies
  • Graft Rejection / mortality*
  • Graft Rejection / therapy*
  • Graft vs Host Disease
  • Hematopoietic Stem Cell Transplantation*
  • Humans
  • Living Donors*
  • Male
  • Middle Aged
  • Myeloablative Agonists / administration & dosage*
  • Neoplasms / mortality
  • Neoplasms / therapy
  • Recurrence
  • Retrospective Studies
  • Salvage Therapy*
  • Transplantation Conditioning*
  • Transplantation, Homologous
  • Vidarabine / administration & dosage
  • Vidarabine / analogs & derivatives*
  • Whole-Body Irradiation*

Substances

  • Myeloablative Agonists
  • Vidarabine
  • fludarabine