Allogeneic peripheral blood stem cell transplantation using reduced intensity versus myeloablative conditioning regimens for the treatment of leukemia.

Reduced intensity conditioning (RIC) have allowed the application of transplantation to older patients and to patients with underlying medical problems. Between October, 1999, and June, 2003, 61 patients with acute leukemia or chronic myeloid leukemia received allogeneic peripheral blood hematopoietic stem cell transplantation (HSCT) from HLA-identical siblings. Thirty-four were conditioned with myeloablative protocols and twenty-seven with RIC regimens. The patients in the myeloablative group were younger (29 vs. 37 years; p < 0.0003), most of them were transplanted in complete remission (74% vs. 59%; p < 0.03), had a shorter interval between diagnosis and HSCT (12 vs. 21 months; p < 0.02) and a greater proportion belonged to standard-risk prognosis (68% vs. 48%; p < 0.1). The median times to neutrophil, platelet and red blood cell engraftment for the myeloablative and RIC groups were 14 versus 11 days (p < 0.009), 17 versus 9 days (p < 0.0001), and 19 versus 12 days (p < 0.007), respectively. Transfusion requirements were lower in the RIC group. Severe mucositis was present in 32% and 7%, respectively (p < 0.01). The proportion of patients having acute graft versus-disease (GVHD), chronic GVHD, and infections was the same, as well as early and late mortality, disease-free survival, and overall survival. Analyzing all the patients together, three factors significantly influenced overall survival: standard risk patients, complete remission at transplant, and the absence of severe acute GVHD. In conclusion, our data suggest that even in high-risk patients, RIC transplantation seems to be as useful as ablative HSCT.

[Hematopoietic cell transplantation. Experience at the Western National Medical Center]. / Trasplante de células hematopoyéticas. Experiencia del Centro Médico Nacional de Occidente.

UNLABELLED: Bone marrow transplantation has recently reached an special place as a therapeutic tool, which was not available ten years ago. AIM AND SETTING: Descriptive information about the first fifteen cases transplanted at Centro Médico Nacional de Occidente, on a third level attention in Guadalajara, Jalisco, Mexico. MATERIAL AND METHODS: Fifteen patients were transplanted, were carried out autologous transplantation in ten patients and five have received allogeneic transplant; one allogeneic transplant was performed with bone marrow aspiration donor, all next donation were taken off from peripheral blood stem cell through apheresis procedures. From autologous transplant 3 with chronic myelogenous leukemia (CML), 3 with Hodgkin's disease, 2 with solid tumor, 1 with high risk acute myelogenous leukemia and 1 large and small cell lymphoma III-B stage. Received allogeneic transplant 4 patients with CML in chronic phase and one with acute lymphoblastic leukemia Ph+. RESULTS: All patients grafted, the median time to achieve > 0.5 x 10(9)/L granulocytes was 14 days (range: 11-18) from autologous and 16 (range: 14-18) days from allogeneic transplant, whereas the median time to achieve > 20 x 10(9)/L platelets was 18 days (range: 15-35) from autologous and 22 days from allogeneic, three patients died into 100 days postprocedure, two allogeneic, from graft versus host disease III-IV degree, and one autologous from interstitial pneumonia, surviving patients have showed +30 days to +1000 days survival. CONCLUSION: With these data we show that this procedure is inexpensive, is factible and possible if it does coexist with multidisciplinary and on time support, interest, dedication on care, and enough information and desire to do it, including official decisions to perform and sponsor its continuity to the people who participate in it.