Ninety-seven patients affected by high-risk hematological malignancies underwent G-CSF primed, unmanipulated bone marrow (BM) transplantation from a related, haploidentical donor. All patients were prepared with an identical conditioning regimen including Thiotepa, Busilvex, Fludarabine (TBF) and antithymocyte globulin given at myeloablative (MAC = 68) or reduced (reduced intensity conditioning (RIC) = 29) dose intensity and received the same GvHD prophylaxis consisting of the combination of methotrexate, cyclosporine, mycofenolate-mofetil and basiliximab. Patients were transplanted in 1st or 2nd CR (early phase: n = 60) or in > 2nd CR or active disease (advanced phase: n = 37). With a median time of 21 days (range 12-38 days), the cumulative incidence (CI) of neutrophil engraftment was 94 ± 3%. The 100-day CI of III-IV grade acute GvHD and the 2-year CI of extensive chronic GvHD were 9 ± 3% and 12 ± 4%, respectively. Overall, at a median follow-up of 2.2 years (range 0.3-5.6), 44 out of 97 (45%) patients are alive in CR. The 5-year probability of overall survival (OS) and disease-free survival (DFS) for patients in early and advanced phase was 53 ± 7 vs 24 ± 8% (P = 0.006) and 48 ± 7 vs 22 ± 8% (P = 0.01), respectively. By comparing MAC with RIC patient groups, the transplant-related mortality was equivalent (36 ± 6 vs 28 ± 9%) while the relapse risk was lower for the MAC patients (22 ± 6 vs 45 ± 11%), who showed higher OS (48 ± 7 vs 29 ± 10%) and DFS (43 ± 7 vs 26 ± 10%). However, all these differences did not reach a statistical significance. In multivariate analysis, diagnosis and recipient age were significant factors for OS and DFS. In conclusion, this analysis confirms, on a longer follow-up and higher number of patients, our previous encouraging results obtained by using MAC and RIC TBF regimen as conditioning for G-CSF primed, unmanipulated BM transplantation from related, haploidentical donor in patients with high-risk hematological malignancies, lacking an HLA-identical sibling or unrelated donor and in need to be urgently transplanted.
Arcese, W., Picardi, A., Santarone, S., De Angelis, G., Cerretti, R., Cudillo, L., et al. (2015). Haploidentical, G-CSF-primed, unmanipulated bone marrow transplantation for patients with high-risk hematological malignancies: an update. BONE MARROW TRANSPLANTATION, 50 Suppl 2, S24-S30 [10.1038/bmt.2015.91].
|Tipologia:||Articolo su rivista|
|Citazione:||Arcese, W., Picardi, A., Santarone, S., De Angelis, G., Cerretti, R., Cudillo, L., et al. (2015). Haploidentical, G-CSF-primed, unmanipulated bone marrow transplantation for patients with high-risk hematological malignancies: an update. BONE MARROW TRANSPLANTATION, 50 Suppl 2, S24-S30 [10.1038/bmt.2015.91].|
|Settore Scientifico Disciplinare:||Settore MED/15|
|Revisione (peer review):||Esperti anonimi|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1038/bmt.2015.91|
|Stato di pubblicazione:||Pubblicato|
|Data di pubblicazione:||giu-2015|
|Titolo:||Haploidentical, G-CSF-primed, unmanipulated bone marrow transplantation for patients with high-risk hematological malignancies: an update|
|Autori:||Arcese, W; Picardi, A; Santarone, S; De Angelis, G; Cerretti, R; Cudillo, L; Pennese, E; Bavaro, P; Olioso, P; Dentamaro, T; Cupelli, L; Chierichini, A; Ferrari, A; Mengarelli, A; Tirindelli, MC; Testi, M; Di Piazza, F; Di Bartolomeo, P|
|Appare nelle tipologie:||01 - Articolo su rivista|