Results of an outpatient-based stem cell allotransplant program using nonmyeloablative conditioning regimens

Using non-myeloablative, immunosuppressive, fludarabine (FLU)-based conditi oning regimens, we have performed allogeneic peripheral blood stem cell tra nsplants in 26 patients (8 with chronic myelogenous leukemia, 6 with acute myelogenous leukemia, 10 with acute lymphoblastic leukemia, 1 with myelodys plasia, and 1 with thalassemia major). Conditioning consisted of FLU/busulp han/cyclophosphamide/cyclosporin-A (CyA)/methotrexate, or FLU/melphalan/CyA /methotrexate. The median granulocyte recovery time to 0.5 x 10(9)/l was 11 days, whereas the median platelet recovery time to 20 x 10(9)/l was 12 day s. Twelve patients did not need red blood cell transfusions, and 8 did not need platelet transfusions. In 21 individuals (81%), the procedure could be completed fully on an outpatient basis. Follow-up times range between 30 a nd 600 days: one patient failed to engraft and recovered endogenous hemopoi esis; six out of 26 patients developed acute graft-versus-host disease (GVH D) whereas 7/22 developed chronic GVHD. Twelve patients (46%) have died, ni ne of them with a relapsing disease and three with GVHD; median post-transp lant survival (SV) was 300 days, whereas the 12-month SV was 42%. The 100-d ay mortality was 3.8% and the transplant-related mortality was 11.5%. This procedure is substantially less costly than its counterpart, using in-hospi tal myeloablative conditioning regimens, and it may represent another appro ach in the management of patients requiring an allogeneic stem cell transpl ant. Am. J. Hematol. 66:241-244, 2001. (C) 2001 Wiley-Liss, Inc.