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  • Nademanee, Auayporn  (2)
  • 2000-2004  (2)
  • 1
    Online Resource
    Online Resource
    The Use of Reduced Intensity Allogeneic Stem Cell Transplantation (alloSCT) for Recurrence after Autologous Stem Cell Transplantation (ASCT) in Hodgkin’s Disease (HD).
    American Society of Hematology ; 2004
    In:  Blood Vol. 104, No. 11 ( 2004-11-16), p. 5115-5115
    Details
    In: Blood, American Society of Hematology, Vol. 104, No. 11 ( 2004-11-16), p. 5115-5115
    Abstract: Autologous stem cell transplantation(ASCT) can cure up to 50% of patients with relapsed or refractory HD. However, for patients who relapse post ASCT or develop post transplant myelodsyplasia (t-MDS), standard chemotherapy options offer little chance of long-term disease free survival (DFS). The use of allogeneic stem cell (alloSCT) may provide a means of control of the HD through the immune mediated effects of an allogeneic approach and also be curative for concomitant t-MDS. While traditional alloSCT in HD patients was fraught with high treatment related mortality, a reduced intensity conditioning regimen may reduce upfront mortality while still providing long term DFS. Between 11/00 and 1/04, fourteen patients underwent reduced intensity alloSCT at the City of Hope Cancer Center. Median age at alloSCT was 31years (range18–47). Median time from HD diagnosis to alloSCT was 36mos (range 3–123). Eleven patients had relapsed post ASCT and one post syngeneic transplant. One of the pts also had t- MDS. The median time from ASCT to alloSCT was 20 mos(range1–45). Ten pts received sibling alloSCT and four unrelated donor. The conditioning regimen consisted of Fludarabine 125mg/m2+ Melphalan 140mg/m2. All patients received a Cyclosporin(CSA) based graft versus host disease (GVHD) prophylaxis regimen; nine in conjunction with Mycophenolate Mofetil and three in conjunction with Methotrexate. Seven developed acute GVHD (3-GrIII-IV). Two patients died of GVHD. There was no other significant regimen related toxicity. Median length of followup for surviving patients is 55 mos. For eleven evaluable pts, one year OS and DFS are 77% (95%CI 49–100) and 58% (95%CI 25–91) respectively (figure 1). The pt with concomitant t-MDS also achieved a hematologic remission. In conclusion, reduced intensity alloSCT may provide a salvage for heavily pretreated patients with HD that have failed ASCT and who otherwise have a poor prognosis, and it can also provide a treatment for late secondary complications of transplantation such as t-MDS.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    URL: Article
    DOI: 10.1182/blood.V104.11.5115.5115
    RVK:
    XA 33000
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2004
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
    Location Call Number Limitation Availability
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  • 2
    Online Resource
    Online Resource
    Dose Intensity and Risk of Relapse for NHL after Allogeneic Transplant.
    American Society of Hematology ; 2004
    In:  Blood Vol. 104, No. 11 ( 2004-11-16), p. 2311-2311
    Details
    In: Blood, American Society of Hematology, Vol. 104, No. 11 ( 2004-11-16), p. 2311-2311
    Abstract: Reduced intensity regimens (RIR) have largely replaced conventional myeloablative regimens (CMR) for patients with NHL undergoing allogeneic transplant. However, the impact of dose reduction on relapse has not been extensively studied. We performed a retrospective analysis of 88 patients conditioned with CMR (n=48) and a RIR (n=40) of fludarabine 125mg/m2 and melphalan 140mg/m2. GVHD prophylaxis was with cyclosporine + MTX +/− prednisone for CMR and cyclosporine + MMF +/− MTX for the RIR. CMR RIR P Value N 48 40 Low grade B-cell 18 16 NS Intermediate grade B-cell 16 12 NS Mantle cell 10 5 NS T cell 4 7 NS Age (years, median, range) 44 (18–54) 51 (20–67) 0.0002 No of prior regimens (median) 3 2 0.02 Previous autologous transplant 5 16 0.002 Chemosensitivity at transplant 24 31 0.007 FTBI regimen 41 0 〈 0.0001 MUD 8 17 0.009 PBSC 16 36 0.0001 Median follow-up (months,range) 65 (33-95) 20 (6-42) CMR were significantly associated with a lower rate of relapse (RR) of 15% versus 38% after RIR (p=0.017). The 1-year TRM was 38% for CMR and 24% for RIR (p=NS). Kaplan-Meier 2-year OS/PFS for CMR is 52%/48% versus 57%/48% for RIR (p=NS). When analyzed by diagnosis, CMR were significantly associated with decreased RR (10% vs 60%, p=0.004) for intermediate grade B-cell (figure 1). Univariate analysis of patient and treatment-related prognostic factors showed improved survival with chemosensitive disease; treatment intensity was the single predictor of relapse for the entire group, but, when stratified by diagnosis, for intermediate grade B-cell only. In conclusion, CMR provide better disease control for intermediate grade B-cell NHL. Figure Figure
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    URL: Article
    DOI: 10.1182/blood.V104.11.2311.2311
    RVK:
    XA 33000
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2004
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
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