Melphalan and purine analog-containing preparative regimens: reduced-intensity conditioning for patients with hematologic malignancies undergoing allogeneic progenitor cell transplantation. Academic Article uri icon

Overview

abstract

  • A reduced-intensity preparative regimen consisting of melphalan and a purine analog was evaluated for allogeneic transplantation in 86 patients who had a variety of hematologic malignancies and were considered poor candidates for conventional myeloablative therapies because of age or comorbidity. Seventy-eight patients received fludarabine 25 mg/m(2) daily for 5 days in combination with melphalan 180 mg/m(2) (n = 66) or 140 mg/m(2) (n = 12). Eight patients received cladribine 12 mg/m(2) continuous infusion for 5 days with melphalan 180 mg/m(2). The median age was 52 years (range, 22-70 years). Disease status at transplantation was either first remission or first chronic phase in 7 patients, untreated first relapse or subsequent remission in 16 patients, and refractory leukemia or transformed chronic myelogenous leukemia in 63 patients. Nonrelapse mortality rates on day 100 were 37.4% for the fludarabine/melphalan combination and 87.5% for the cladribine/melphalan combination. The median percentage of donor cells at 1 month in 75 patients was 100% (range, 0%-100%). The probability of grade 2-4 and 3-4 acute graft-versus-host disease was 0.49 (95% CI, 0.38-0.60) and 0.29 (95% CI, 0.18-0.41), respectively. Disease-free survival at 1 year was 57% for patients in first remission or chronic phase and 49% for patients with untreated first relapse or in a second or later remission. On multivariate analysis the strongest predictor for disease-free survival was a good or intermediate risk category. In summary, fludarabine/melphalan combinations are feasible in older patients with associated comorbidities, and long-term disease control can be achieved with reduced-intensity conditioning in this population.

authors

  • Giralt, Sergio
  • Thall, P F
  • Khouri, Issa
  • Wang, Xuemei
  • Braunschweig, Ira
  • Ippolitti, Cindy
  • Claxton, David
  • Donato, Michele
  • Bruton, Jill
  • Cohen, Agueda
  • Davis, Marilyn
  • Andersson, B S
  • Anderlini, Paolo
  • Gajewski, James
  • Kornblau, Steven
  • Andreeff, Michael
  • Przepiorka, Donna
  • Ueno, N T
  • Molldrem, Jeff
  • Champlin, Richard

publication date

  • February 1, 2001

Research

keywords

  • Antineoplastic Combined Chemotherapy Protocols
  • Cladribine
  • Hematologic Neoplasms
  • Hematopoietic Stem Cell Transplantation
  • Melphalan
  • Vidarabine

Identity

Scopus Document Identifier

  • 0035254219

Digital Object Identifier (DOI)

  • 10.1182/blood.v97.3.631

PubMed ID

  • 11157478

Additional Document Info

volume

  • 97

issue

  • 3