Allogeneic stem cell transplantation after fludarabine, melphalan and thymoglobulin followed by early withdrawal of prophylactic immunosuppression could be an effective approach to patients with acute lymphoblastic leukemia

作者：Raida L^*; Rusinakova Z; Szotkowska R; Kuba A; Faber E; Rohon P; Szotkowski T; Hubacek J; Pikalova Z; Jarosova M; Divoka M; Indrak K; Langova K; Skoumalova I; Papajik T

来源：Neoplasma, 2015, 62(5): 805-811.

DOI：10.4149/neo_2015_097

• acute lymphoblastic leukemia
• allogeneic hematopoietic stem cell transplantation
• fludarabine
• melphalan
• thymoglobulin
• graft-versus-host disease prophylaxis

Presented are results of allogeneic hematopoietic stem cell transplantations (HSCTs) in 13 patients with high-risk acute lymphoblastic leukemia (ALL) in the first complete remission after a reduced intensity conditioning combining fludarabine (150 mg/m(2)) and melphalan (140 mg/m2) with thymoglobulin (4.5 mg/kg). The immunosuppressive effect of T-cell depletion reducing the risk of graft-versus-host disease (GVHD) and non-relapse mortality was compensated by early initiation of reduction and withdrawal of prophylactic immunosuppression aimed at maintaining effective immunological antileukemic control. The median post-transplant follow-up was 23 (range, 10-65) months. Stable engraftment of donor's hematopoiesis was achieved in all patients. Acute GVHD was observed in two cases (15.4%); the chronic form was not noted. Two patients (15.4%) relapsed with ALL at 3 and 16 months after transplantation. During the above post-transplant follow-up, all 13 recipients were alive, with a probability of 2-year disease-free survival of 76.9% (95% CI 51-100%). Although the results were obtained with a small pilot study group it may be assumed that, given the prognostic risk of most patients and the nearly 2-year median post-transplant follow-up, the approach may be considered as an alternative to HSCTs after traditional my-eloablative or reduced conditioning regimens with standard GVHD prophylaxis.

• 出版日期2015