Home Neoplasma 2015 Neoplasma Vol.62, No.5, p.805-811, 2015

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Neoplasma Vol.62, No.5, p.805-811, 2015

Title: Allogeneic stem cell transplantation after fludarabine, melphalan and thymoglobulin followed by early withdrawal of prophylactic immunosuppression could be an effective approach to patients with acute lymphoblastic leukemia
Author: L. RAIDA, Z. RUSINAKOVA, R. SZOTKOWSKA, A. KUBA, E. FABER, P. ROHON, T. SZOTKOWSKI, J. HUBACEK, Z. PIKALOVA, M. JAROSOVA, M. DIVOKA, K. INDRAK, K. LANGOVA, I. SKOUMALOVA, T. PAPAJIK

Abstract: Presented are results of allogeneic hematopoietic stem cell transplantations (HSCTs) in 13 patients with high-risk acute lymphoblastic leukemia (ALL) in the first complete remission after a reduced intensity conditioning combining fludarabine (150 mg/m2) and melphalan (140 mg/m2) with thymoglobulin (4.5 mg/kg). The immunosuppressive effect of T-cell depletion reducing the risk of graft-versus-host disease (GVHD) and non-relapse mortality was compensated by early initiation of reduction and withdrawal of prophylactic immunosuppression aimed at maintaining effective immunological antileukemic control. The median post-transplant follow-up was 23 (range, 10-65) months. Stable engraftment of donor’s hematopoiesis was achieved in all patients. Acute GVHD was observed in two cases (15.4%); the chronic form was not noted. Two patients (15.4%) relapsed with ALL at 3 and 16 months after transplantation. During the above post-transplant follow-up, all 13 recipients were alive, with a probability of 2-year disease-free survival of 76.9% (95% CI 51-100%). Although the results were obtained with a small pilot study group it may be assumed that, given the prognostic risk of most patients and the nearly 2-year median post-transplant follow-up, the approach may be considered as an alternative to HSCTs after traditional myeloablative or reduced conditioning regimens with standard GVHD prophylaxis.

Keywords: acute lymphoblastic leukemia, allogeneic hematopoietic stem cell transplantation, fludarabine, melphalan, thymoglobulin, graft-versus-host disease prophylaxis
Published online: 03-Aug-2015
Year: 2015, Volume: 62, Issue: 5 Page From: 805, Page To: 811
doi:10.4149/neo_2015_097


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