Allogeneic peripheral blood stem cell transplantation (PBSCT) utilizing nonmyeloablative conditioning regimens (mini transplants) are promising due to their potential for reduction in toxicity from the conditioning regimen compared to conventional myeloablative conditioning. However, post transplant complications such as acute GVHD and CMV antigenemia have not been previously compared. We performed a cohort analysis on 60 consecutive patients at a single center during the period of January 1998 to March 2000. We compared the cumulative incidence of GVHD and CMV antigenemia between the two groups. Forty four patients received standard allogeneic PBSCT (STD) compared with 16 who received mini PBSCT (MINI). The diagnoses included a range of hématologie malignant and non-malignant disorders. STD transplants were performed for AML 17, CML 7, NHL 7, MDS 4, ALL 4, MM 2, SCID l, HD l, SAA 1. Mini transplants were performed for AML 7, NHL 2, HD 2, MM 2, MPD 1, CML 1, ALL 1. MINI transplants were performed using fludarabine, ATGAM and busulfan based regimen. All patients were followed for 100 days unless they failed. Mean age in the two groups was 40 for STD vs. 48 for MINI (p=0.08). The median time to engraftment (ANC 500) was 15 days for STD vs. 11 days for MINI p=0.0011, Wilcoxon). The incidence of acute GVHD grade II-IV occurring within 100 days was 68.4 % for STD vs. 45.5% for MINI (p= 0.16). CMV antigenemia requiring treatment was detected in 21 of 44 (47.4%) patients in the STD arm (p=0.48) compared with 6 of 16 (37.5%) in the MINI arm, of which 2 from STD and none from MINI group developed CMV pnuemonia. In addition, we performed comparisons between STD and MINI stratified by diagnosis. Stratification did not change the conclusions. Our results indicate that acute GVHD occurred at a higher but not statistically significant different rate in the STD compared with the MINI group, though the statistical power was limited by the sample size. The rates of CMV antigenemia were comparable between groups. Using randomized clinical trial designs, continued evaluation of mini conditioning regimens in allogeneic PBSCT should be encouraged.
|Original language||English (US)|
|Issue number||11 PART I|
|State||Published - 2000|
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