Haematopoietic cell transplantation with non-myeloablative conditioning in Denmark: Disease-specific outcome, complications and hospitalization requirements of the first 100 transplants
Abstract:We analysed the outcome and hospitalization requirements of the first 100 patients (Hodgkin's disease (HD), N=13; multiple myeloma (MM), N=14; chronic lymphocytic leukaemia (CLL), N=12; non-Hodgkin's lymphoma (NHL), N=17; myelodysplastic syndrome (MDS), N=18; acute myeloid leukaemia (SML), N=24 and chronic myeloid leukaemia (CML), N=2) treated in Denmark with haematopoietic cell transplantation after non-myeloablative conditioning with TBI 2 Gy±fludarabine. The cumulative incidence of acute GVHD grade II–IV and extensive chronic GVHD was 67 and 49 %. After a median follow-up of 534 days, the overall survival, progression free survival (PFS), relapse-related mortality and treatment-related mortality (TRM) were 59, 50, 25 and 17 %, respectively. Patients with CLL, NHL, AML and MDS with <5% blasts at any time had a favourable outcome with a PFS of 61 – 71 %. Patients with MM, HD and MDS and a history of <5% blasts had a less favourable outcome with a PFS of 19–38% (P=0.001). The cumulative incidence of discontinuation of immunosuppression was 37%. During the first and second year post transplant, patients experienced a mean of 41 and 13 outpatient clinic visits, and 53 and 16 days of hospitalization. Sixteen patients were admitted to the intensive care unit, of whom eight are still alive. In conclusion we found that allogeneic HCT following non-myeloablative conditioning is a valuable treatment option in patients with haematological malignancies without other potentially curative treatment options. Despite low TRM, the non-myeloablative allogeneic HCT procedure is associated with considerable morbidity, requiring frequent hospitalization and outpatient visits throughout the first and second year post-transplant.
Document Type: Abstract
Affiliations: 1: The Allogeneic Haematopoietic Cell Transplantation Laboratory, Hæmatologisk Klinik 4041, Rigshospitalet 2: Klinisk Immunologisk afdeling 7631, Rigshospitalet 3: Knoglemarvs-transplantationsafsnittet, Hæmatologisk Klinik, Rigshospitalet 4: Blodbanken, Klinisk immunologisk afdeling, Rigshospitalet
Publication date: 2008-05-01