التفاصيل البيبلوغرافية
| العنوان: |
Nonmyeloablative Haploidentical Bone Marrow Transplantation with Post-Transplantation Cyclophosphamide for Pediatric and Young Adult Patients with High-Risk Hematologic Malignancies. |
| المؤلفون: |
Klein, Orly R.1 oklein2@jhmi.edu, Buddenbaum, Jessica2, Tucker, Noah2, Chen, Allen R.1, Gamper, Christopher J.1, Loeb, David1, Zambidis, Elias1, Llosa, Nicolas J.1, Huo, Jeffrey S.1, Robey, Nancy1, Holuba, Mary Jo1, Kasamon, Yvette L.3, McCurdy, Shannon R.3, Ambinder, Richard3, Bolaños-Meade, Javier3, Luznik, Leo3, Fuchs, Ephraim J.3, Jones, Richard J.3, Cooke, Kenneth R.1, Symons, Heather J.1 |
| المصدر: |
Biology of Blood & Marrow Transplantation. Feb2017, Vol. 23 Issue 2, p325-332. 8p. |
| مصطلحات موضوعية: |
*BONE marrow transplantation, *CYCLOPHOSPHAMIDE, *DISEASES in young adults, *HEMATOLOGIC malignancies, *IMMUNOSUPPRESSION, *THERAPEUTICS, *DISEASE risk factors |
| مستخلص: |
Lower-intensity conditioning regimens for haploidentical blood or marrow transplantation (BMT) are safe and efficacious for adult patients with hematologic malignancies. We report data for pediatric/young adult patients with high-risk hematologic malignancies (n = 40) treated with nonmyeloablative haploidentical BMT with post-transplantation cyclophosphamide from 2003 to 2015. Patients received a preparative regimen of fludarabine, cyclophosphamide, and total body irradiation. Post-transplantation immunosuppression consisted of cyclophosphamide, mycophenolate mofetil, and tacrolimus. Donor engraftment occurred in 29 of 32 (91%), with median time to engraftment of neutrophils >500/µL of 16 days (range, 13 to 22) and for platelets >20,000/µL without transfusion of 18 days (range, 12 to 62). Cumulative incidences of acute graft-versus-host disease (GVHD) grades II to IV and grades III and IV at day 100 were 33% and 5%, respectively. The cumulative incidence of chronic GVHD was 23%, with 7% moderate-to-severe chronic GVHD, according to National Institutes of Health consensus criteria. Transplantation-related mortality (TRM) at 1 year was 13%. The cumulative incidence of relapse at 2 years was 52%. With a median follow-up of 20 months (range, 3 to 148), 1-year actuarial overall and event-free survival were 56% and 43%, respectively. Thus, we demonstrate excellent rates of engraftment, GVHD, and TRM in pediatric/young adult patients treated with this regimen. This approach is a widely available, safe, and feasible option for pediatric and young adult patients with high-risk hematologic malignancies, including those with a prior history of myeloablative BMT and/or those with comorbidities or organ dysfunction that preclude eligibility for myeloablative BMT. [ABSTRACT FROM AUTHOR] |
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