부산대학교 도서관

A total of 50 consecutive patients (median age, 57.5 years) with AML (n = 30) or myelodysplasia (MDS, n = 20) underwent HLA matched related donor (MRD, n = 27) or unrelated donor (MUD, n = 23) peripheral blood hematopoietic cell transplantation after nonmyeloablative CY/fludarabine (Flu) conditioning. GVHD prophylaxis included CsA (n = 19) [+ or -] mycophenolate mofetil (n = 31). At a median follow-up of 59 months, 21 patients (42%) were alive without evidence of disease. By Kaplan-Meier analysis, year 1-4 disease-free survival (DFS) and OS estimates were 0.50/0.58, 0.40/0.46, 0.37/0.43 and 0.37/0.41. MUD recipients were engrafted quickly (13.5 days) compared to MRD recipients (16 days) and relapsed/progressed less frequently (P = 0.005). Overall grade 3/4 acute GVHD (aGVHD) occurred in 26% in the absence of antecedent mucositis and was associated with chronic GVHD (cGVHD) and poor OS. Extensive cGVHD developed in 51.2% of 100 day survivors. Rates of aGVHD, cGVHD and survival were similar between MRD and MUD recipients. Of 14 survivors with cGVHD, 5 (35.7%) experienced resolution off immunosuppression, suggesting that tolerance with HLA matched grafts is possible at an advanced age by this method. This study provides further evidence for prolonged DFS after CY/Flu MRD allotransplantation for AML/MDS, and extends the findings to older patients and those with unrelated donors. Bone Marrow Transplantation (2010) 45, 1300-1308; doi: 10.1038/bmt.2009.348; published online 11 January 2010 Keywords: nonmyeloablative; minimal intensity; transplantation; leukemia; myelodysplasia
Introduction Allogeneic hematopoietic cell transplantation (HCT) is an established therapy for AML and myelodysplasia (MDS). (1-5) Myeloablative conditioning regimens have traditionally been used for treatment; however, recognition of alloimmune anticancer [...]