Akademik Veri Yönetim Sistemi
Transplantation and Cellular Therapy, cilt.28, sa.3, ss.245, 2022 (Scopus)
Introduction: Reduced-intensity conditioning (RIC) regimens were developed in an effort to allow more patients to receive allogeneic stem cell transplantation as a potentially curative treatment. There is great variety in RIC regimens used by different transplant centers worldwide. The optimum RIC regimen has not been defined. We aimed to assess outcomes of uniform RIC regimen which consists of fludarabine160 mg/m2, melphalan 75 mg/m2 and TBI 200 cGY.
Patients and methods: We evaluated outcomes of patients who underwent stem cell transplantation (SCT) with a conditioning regimen consisting of fludarabine 160 mg/m2 over 4 days ( days -5 to -2), melphalan 75 mg/m2 ( day -2) and TBI 200 cGY between November 2019 and May 2021. All patients received unmanipulated peripheral blood stem cell as a a graft source from HLA matched sibling donors (n=10), unrelated donors (n=13) or haploidentical related donors ( n=10). GVHD prophylaxis consisted of calcineurin inhibitors (CNI) and mycophenolate (MMF) in all patients . Patients transplanted with unrelated and haploidentical donor also received posttransplant cyclophosphamide in addition to CNI and MMF as a part of GVHD prophylaxis. Thirty-three patients with hematologic malignancies (AML:15, ALL:4, MDS:3, DLBCL:7, Hodgkin disease:2, multiple myeloma:1, primary myelofibrosis:1) enrolled into the study.
Results: Median age was 59 ( range 24 to 67 years) and majority of patients (57.6%) was >55 years. At the time of transplantation, 9 patients (27.3%) were experiencing first CR, 10 patients (30.3%) were in later CR and 14 patients (42.4%) had active disease. Three of the 33 patients were second transplants for relapses after first transplant. Two patients died before evaluation of chimerism at day 30. All other patients achieved full peripheral blood donor chimerism by day 30. Median time to neutrophil and platelet engraftment was 15 and 17 days. Treatment related mortality (TRM) at 100 days was 18%. The cumulative incidence of acute grade II-IV GVHD was 37.5%. The median duration of follow up was 6 months ( range 0 to 22). DFS and OS at 6 months were 62% anf 62%. The only independent prognostic factor affecting TRM and survival was primary or secondary poor graft function.
Conclusion: Our data demonstrate that despite the short median follow-up time, FluMel75TBI200 conditioning regimen appears to be a tolerable RIC regimen with good engraftment, acceptable TRM and disease control in this group of patients most of whom were elderly and with later CR or active disease.