Evidence for a graft-versus-leukemia effect after allogeneic peripheral blood stem cell transplantation with reduced-intensity conditioning in acute myelogenous leukemia and myelodysplastic syndromes

• Published in: Blood Vol. 100; no. 6; pp. 2243 - 2245
• Main Authors: Martino, Rodrigo, Caballero, Marı́a Dolores, Pérez Simón, José Antonio, Canals, Carmen, Solano, Carlos, Urbano-Ispı́zua, Alvaro, Bargay, Joan, Léon, Angel, Sarrá, Josep, Sanz, Guillermo F., Moraleda, José Marı́a, Brunet, Salut, San Miguel, Jesús, Sierra, Jorge
• Format: Journal Article
• Language: English
• Published: Washington, DC Elsevier Inc 15-09-2002; The Americain Society of Hematology
• Subjects: Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Biological and medical sciences; Bone marrow, stem cells transplantation. Graft versus host reaction; Busulfan - administration & dosage; Female; Follow-Up Studies; Graft vs Host Disease; Graft vs Leukemia Effect; Hematologic and hematopoietic diseases; Hematopoietic Stem Cell Transplantation - adverse effects; Humans; Incidence; Leukemia, Myeloid, Acute - drug therapy; Leukemia, Myeloid, Acute - mortality; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Male; Medical sciences; Middle Aged; Myelodysplastic Syndromes - drug therapy; Myelodysplastic Syndromes - mortality; Prospective Studies; Survival Analysis; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation Conditioning - methods; Transplantation, Isogeneic - adverse effects; Vidarabine - administration & dosage; Vidarabine - analogs & derivatives; Human; Graft versus leukemia reaction; Acute; Stem cell; Related donor; Hematopoietic cell; Homograft; Malignant hemopathy; Non myeloablative treatment; Myelodysplastic syndrome; Blood cell; Treatment; Graft; Conditioning; Therapeutic protocol; Histocompatibility; Acute myelocytic leukemia
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2002-02-0400

We report the results of a prospective study of a reduced-intensity conditioning (RIC) regimen followed by allogeneic peripheral blood stem cell transplantation (PBSCT) from an HLA-identical sibling in 37 patients with acute myeloid leukemia (AML; n = 17) or myelodysplastic syndrome (MDS; n = 20). The median age was 57 years, and 22 (59%) were beyond the early phase of their disease. The incidence of grade II to IV acute graft-versus-host disease (GVHD) was 19% (5% grade III-IV), and the 1-year incidence of chronic extensive GVHD was 46%. With a median follow-up of 297 days (355 days in 24 survivors), the 1-year probability of transplant-related mortality was 5%, and the 1-year progression-free survival was 66%. The 1-year incidence of disease progression in patients with and without GVHD was 13% (95% CI, 4%-34%) and 58% (95% CI, 36%-96%), respectively (P = .008). These results suggest that a graft-versus-leukemia effect plays a crucial role in reducing the risk of relapse after a RIC allograft in AML and MDS.