Document Detail


Fludarabine with cytarabine followed by reduced-intensity conditioning and allogeneic hematopoietic stem cell transplantation in patients with poor-risk chronic lymphocytic leukemia.
MedLine Citation:
PMID:  23014659     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Allogeneic stem cell transplantation (SCT) is a treatment option for patients with poor-risk chronic lymphocytic leukemia (CLL). Sequential use of chemotherapy and reduced-intensity conditioning has been proposed to improve the treatment outcomes. Fludarabine (30 mg/m(2)/day) and cytarabine (2 g/m(2)/day) for 4 days (combination of fludarabine with cytarabine; FAraC) were used for cytoreduction. After 3 days of rest, reduced intensity conditioning (RIC) was carried out consisting of 4 Gy total body irradiation, 10-20 mg/kg/day antithymocyte globulin for 3 days, and 40-60 mg/kg/day cyclophosphamide for 2 days. The median time of neutrophil engraftment was 16 days. The most frequent toxicities were grades III/IV infections in 12 of 15 cases and gastrointestinal toxicities in 8 of 15 cases. Remission (complete remission + partial remission) was achieved in 14 of 15 patients (93 %), minimal residual disease negativity according to flowcytometric analysis was observed in 10 patients. Nonrelapse mortality after 1 and 2 years was 7 and 13 %, respectively. After the median follow-up from SCT of 30 months, 80 % of patients were alive (12/15), three patients have died, and three relapses occurred. The FAraC-RIC protocol seems to be a promising approach to the treatment of poor-risk CLL with a high response rate of 93 % and favorable progression-free survival and overall survival of 70 and 85 % at 2 years after SCT, respectively. Other prospective clinical trials are needed to confirm the results of this novel therapeutic strategy.
Authors:
Marta Krejci; Michael Doubek; Yvona Brychtova; Olga Stehlikova; Jana Chovancova; Boris Tichy; Hana Skuhrova Francova; Milan Navratil; Miroslav Tomiska; Ondrej Horky; Sarka Pospisilova; Jiri Mayer
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-09-27
Journal Detail:
Title:  Annals of hematology     Volume:  92     ISSN:  1432-0584     ISO Abbreviation:  Ann. Hematol.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-01-11     Completed Date:  2013-03-07     Revised Date:  2013-05-27    
Medline Journal Info:
Nlm Unique ID:  9107334     Medline TA:  Ann Hematol     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  249-54     Citation Subset:  IM    
Affiliation:
Department of Internal Medicine, Hematology and Oncology, University Hospital Brno and Masaryk University, Jihlavska 20, Brno, Czech Republic. mkrejci@fnbrno.cz
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MeSH Terms
Descriptor/Qualifier:
Adult
Antibodies, Monoclonal, Humanized / therapeutic use
Antibodies, Monoclonal, Murine-Derived / administration & dosage
Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
Bone Marrow Transplantation / adverse effects
Cyclophosphamide / administration & dosage
Cytarabine / administration & dosage
Dexamethasone / administration & dosage
Disease Progression
Drug Resistance, Neoplasm
Female
Humans
Immunosuppressive Agents / therapeutic use
Kaplan-Meier Estimate
Leukemia, Lymphocytic, Chronic, B-Cell / drug therapy*,  surgery
Male
Middle Aged
Neoplasm, Residual
Peripheral Blood Stem Cell Transplantation* / adverse effects
Prednisolone / administration & dosage
Prospective Studies
Recurrence
Risk
Salvage Therapy
Transplantation Conditioning / adverse effects,  methods*
Transplantation, Homologous
Treatment Outcome
Vidarabine / administration & dosage,  analogs & derivatives
Vincristine / administration & dosage
Whole-Body Irradiation
Chemical
Reg. No./Substance:
0/Antibodies, Monoclonal, Humanized; 0/Antibodies, Monoclonal, Murine-Derived; 0/Immunosuppressive Agents; 0/rituximab; 147-94-4/Cytarabine; 3A189DH42V/alemtuzumab; 50-02-2/Dexamethasone; 50-18-0/Cyclophosphamide; 50-24-8/Prednisolone; 5536-17-4/Vidarabine; 57-22-7/Vincristine; P2K93U8740/fludarabine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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