Between 11-19-97 and 2-10-00, 21 patients with hematologic malignancies underwent an unrelated, bone marrow transplant (UBMT). Five patients had ALL; 6, CML; 3, NHL; 4, AML, and 3 MM. Twelve (57%) patients were male and 9 (43%) were female. Median age of the group was 39 years (with a range of 13 to 62). Nineteen (90%) patients received high dose chemotherapy followed by allogeneic stem cell rescue (17 from bone marrow [BM] and 2 from peripheral stem cells [PBSC]) and 2 had non-myeloablative bone marrow transplant. Conditioning therapy consisted of thiotepa, cyclophosphamide, ATG and TBI in 16 patients; melphalan, cyclophosphamide, ATG and methotrexate in 1 patient; melphalan, cyclophosphamide, and ATG in 1 patient, and TBI, cyclophosphamide and ATG in 1 patient. The 2 non-myeloablative transplants received TBI, cyclophosphamide and ATG. Graft consisted of 16 T cell depleted (TCD) BM, 1 TCD PBSC, 2 PBSC and 2 BM. There is compatibility data in 19 patients: 10 patients were identical HLA match, 6 had 1 mismatch and 3 had 2. One patient with CML received a second UBMT (from the same donor). Median survival after transplant was 106 days. Causes of death were 3 aspergillosis, 2 candidemias, 2 septicemias, 1 disseminated CMV, 1 gangrenous cholecystitis, 1 possible PE, 1 transfusion related lung injury, 1 progressive disease, 1 TTP, 1 respiratory failure, 1 graft failure, 1 GI bleeding due to GVHD. Five (24%) patients are alive 35, 38, 40, 41 and 41 months after transplant. These are one female with APL, 1 female with ALL, 1 male with MM, 1 male and 1 female with CML. The patient with MM relapsed and is awaiting donor lymphocyte infusion. Both patients with CML relapsed but returned to hematological and molecular complete remission after donor lymphocyte infusions. The other 2 patients are in unmaintained complete remission. These 5 long-term survivors received the same conditioning regimen and graft type: thiotepa, cyclophosphamide, ATG and TBI; and TCD BM. Of the 3 currently on CR, only 2 had acute GVHD (skin) and 2 had chronic GVHD (skin and liver, and skin, liver and GI). Even when this procedure carries high morbidity and mortality, still remains the only potential curative option for some patients with refractory hematologic malignancies, and long-term survival is possible. Elegible patients should be enrolled in the appropriate clinical trials to improve outcomes of UBMT.
Full conference title:
43rd American Society of Hematology (ASH) Annual Meeting
- ASH 43rd (2001)