Allogeneic hematopoietic stem-cell transplantation after nonmyeloablative preparative regimens: Impact of pretransplantation and posttransplantation factors on outcome

Purpose: To analyze the impact of pre- and posttransplantation factors on t he outcome of allogeneic transplantation after nonmyeloablative conditionin g regimens. patients and Methods: Ninety-two allogeneic transplantations after nonmyelo ablative preparative regimens were reported to the Societe Francaise de Gre ffe de Moelle Registry registry. Initial diagnoses were lymphoid diseases ( n = 22), myeloma (n = 14), acute leukemia and myelodysplasia (n = 41), chro nic myelogenous leukemia (n = 12), and solid tumors (n = 3). Forty-six pati ents had previously received a transplant, and 49 held progressive disease before transplantation. Three types of conditioning regimens were used with fludarabine or antithymocyte globulins. Eighty-nine patients underwent tra nsplantation, 60 from peripheral-blood progenitor cells. Eighty-six patient s received graft-versus-host disease (GHVD) prophylaxis for a median durati on of 53 days. Results: Seventy-nine patients engrafted, with 40 complete and 21 mixed chi merisms. The acute GHVD rare at 3 months was 50% +/- 11%. Fifty-two patient s achieved complete remission and 12, partial remission. At 18 months after transplantation, the overall survival (OS) and the transplant-related mort ality (TRM) were 32% +/- 12% and 38% +/- 14%, respectively. initial diagnos is and disease status before transplantation significantly influenced survi val. Age and GHVD prophylaxis type significantly influenced TRM. We also sh owed an impact of GHVD, prophylaxis duration on OS and TRM. in multivariate analysis, three factors remained of prognostic value on OS: initial diagno sis, disease status at transplantation, and GHVD prophylaxis duration. Conclusion: This series shows encouraging results from nonmyeloablative con ditioning regimens before allotransplantation and demonstrates the impact o f some pre- and posttransplantation factors on outcome after transplantatio n. (C) 2001 by American Society of Clinical Oncology.