The use of allogeneic stem cell transplantation is usually restricted to patients (pts) younger than 55 years of age due to the excessive transplant related mortality (TRM) observed in older pts. The low risk of TRM from non-myeloablative transplants makes the procedure applicable to older pts. Here we report 9 pts with a median age of 61 years (range 57 to 67) who underwent conditioning with fludarabine 25mg/m2x3 days and cyclophosphamide 750mg/nvx 3days followed by PBCT from a G-CSF stimulated HLA identical sibling donor. As GVHD prophylaxis 6 pts received cyclosporin (CSA) and mini-dose methotrexate, 2 pts CSA and mycophenolate mofetyl and 1 pt CSA and prednisone. CSA was given until day 60 then tappered off if no GVHD occured. All pts received low dose amphotericin B at 0.3mg/Kg as antifungal prophylaxis during neutropenia, CMV prophylaxis with gancyclovir and PCP prophylaxis. Diagnosis included secondary AML in 2 pts, multiple myeloma in 1 pt. CML in accelerated phase in Ipt, AL amyloid in 1 pt, mantle cell lymphoma in Ipt, secondary MDS in Ipt, NK leukemia in 1 pt and chronic myelomonocytic leukemia in another. There were 3 females and 6 males. Two pts had previous transplants (1 allogeneic and ! autologous). Only one pt was in CR at time of therapy. Median transplant dose was 5.2x10" CD34+cells/Kg and 2.2x10" CD3+cells/Kg. Severe mucositis and VOD did not occur. The pt with amyloid experienced acute renal failure requiring dialysis. Hématologie nadirs were brief with a median time to ANC>0.5xlO /L of 10 days (range 7 to 17) and a platlet count > 20xlO'/L of 11 days (range 6 to 13). Six pts experienced grade III-1V acute GVHD. GVHD contributed to the death of 3 pts. One pt has chronic GVHD. Seven pts survived more than 28 days. Two early deaths were caused by disseminated aspergillosis in 1 pt and engraftment syndrome in another. One pt with multiple myeloma died of disease progression . Three pts are alive at +15, +12, +6 months. All are in CR. We conclude that this approach seems feasible in an older population. Modifications are needed to reduce the incidence of GVHD.
|Original language||English (US)|
|Issue number||11 PART II|
|State||Published - Dec 1 2000|
All Science Journal Classification (ASJC) codes
- Cell Biology