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The development of a myeloablative, reduced-toxicity, conditioning regimen for cord blood transplantation.

Identifieur interne : 003B76 ( PubMed/Corpus ); précédent : 003B75; suivant : 003B77

The development of a myeloablative, reduced-toxicity, conditioning regimen for cord blood transplantation.

Auteurs : Rohtesh S. Mehta ; Antonio Di Stasi ; Borje S. Andersson ; Yago Nieto ; Roy Jones ; Marcos De Lima ; Chitra Hosing ; Uday Popat ; Partow Kebriaei ; Betul Oran ; Amin Alousi ; Katayoun Rezvani ; Muzaffar Qazilbash ; Qaiser Bashir ; Catherine Bollard ; Laurence Cooper ; Laura Worth ; Priti Tewari ; Ian Mcniece ; Kaci Willhelm ; Richard Champlin ; Elizabeth J. Shpall

Source :

RBID : pubmed:24169268

English descriptors

Abstract

Cord blood transplantation is being used with increasing frequency for patients with high-risk hematologic malignancies. Myeloablative preparative regimens provide antitumor efficacy and facilitate engraftment but are associated with higher morbidity and nonrelapse mortality rates than nonablative regimens. We evaluated 3 sequential myeloablative regimens in the cord blood transplant setting. Regimen 1 (melphalan, fludarabine, and thiotepa) produced prompt engraftment and minimal engraftment failure but was associated with a high nonrelapse mortality rate. Regimen 2 (busulfan and fludarabine) was very well tolerated but was associated with a high rate of engraftment failure and relapse. Regimen 3 (busulfan, clofarabine, fludarabine, and low-dose total body irradiation given 9 days after the chemotherapy) was associated with a low rate of engraftment failure but was logistically difficult to administer. Finally, regimen 3 that included the total body irradiation given immediately after the chemotherapy was well tolerated, with prompt engraftment and tumor control. This latter regimen appears to be effective in preliminary studies and warrants further evaluation.

DOI: 10.1016/j.clml.2013.08.006
PubMed: 24169268

Links to Exploration step

pubmed:24169268

Le document en format XML

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<nlm:affiliation>Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX.</nlm:affiliation>
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<name sortKey="Qazilbash, Muzaffar" sort="Qazilbash, Muzaffar" uniqKey="Qazilbash M" first="Muzaffar" last="Qazilbash">Muzaffar Qazilbash</name>
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<name sortKey="Willhelm, Kaci" sort="Willhelm, Kaci" uniqKey="Willhelm K" first="Kaci" last="Willhelm">Kaci Willhelm</name>
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<nlm:affiliation>Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX.</nlm:affiliation>
</affiliation>
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<name sortKey="Champlin, Richard" sort="Champlin, Richard" uniqKey="Champlin R" first="Richard" last="Champlin">Richard Champlin</name>
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<nlm:affiliation>Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX.</nlm:affiliation>
</affiliation>
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<name sortKey="Shpall, Elizabeth J" sort="Shpall, Elizabeth J" uniqKey="Shpall E" first="Elizabeth J" last="Shpall">Elizabeth J. Shpall</name>
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<term>Child, Preschool</term>
<term>Cord Blood Stem Cell Transplantation (methods)</term>
<term>Fetal Blood (transplantation)</term>
<term>Granulocyte Precursor Cells (drug effects)</term>
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<term>Hematologic Neoplasms (therapy)</term>
<term>Humans</term>
<term>Infant</term>
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<div type="abstract" xml:lang="en">Cord blood transplantation is being used with increasing frequency for patients with high-risk hematologic malignancies. Myeloablative preparative regimens provide antitumor efficacy and facilitate engraftment but are associated with higher morbidity and nonrelapse mortality rates than nonablative regimens. We evaluated 3 sequential myeloablative regimens in the cord blood transplant setting. Regimen 1 (melphalan, fludarabine, and thiotepa) produced prompt engraftment and minimal engraftment failure but was associated with a high nonrelapse mortality rate. Regimen 2 (busulfan and fludarabine) was very well tolerated but was associated with a high rate of engraftment failure and relapse. Regimen 3 (busulfan, clofarabine, fludarabine, and low-dose total body irradiation given 9 days after the chemotherapy) was associated with a low rate of engraftment failure but was logistically difficult to administer. Finally, regimen 3 that included the total body irradiation given immediately after the chemotherapy was well tolerated, with prompt engraftment and tumor control. This latter regimen appears to be effective in preliminary studies and warrants further evaluation.</div>
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<Title>Clinical lymphoma, myeloma & leukemia</Title>
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<AbstractText>Cord blood transplantation is being used with increasing frequency for patients with high-risk hematologic malignancies. Myeloablative preparative regimens provide antitumor efficacy and facilitate engraftment but are associated with higher morbidity and nonrelapse mortality rates than nonablative regimens. We evaluated 3 sequential myeloablative regimens in the cord blood transplant setting. Regimen 1 (melphalan, fludarabine, and thiotepa) produced prompt engraftment and minimal engraftment failure but was associated with a high nonrelapse mortality rate. Regimen 2 (busulfan and fludarabine) was very well tolerated but was associated with a high rate of engraftment failure and relapse. Regimen 3 (busulfan, clofarabine, fludarabine, and low-dose total body irradiation given 9 days after the chemotherapy) was associated with a low rate of engraftment failure but was logistically difficult to administer. Finally, regimen 3 that included the total body irradiation given immediately after the chemotherapy was well tolerated, with prompt engraftment and tumor control. This latter regimen appears to be effective in preliminary studies and warrants further evaluation.</AbstractText>
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<LastName>Mehta</LastName>
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<LastName>Di Stasi</LastName>
<ForeName>Antonio</ForeName>
<Initials>A</Initials>
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<Affiliation>Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX.</Affiliation>
</AffiliationInfo>
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<LastName>Andersson</LastName>
<ForeName>Borje S</ForeName>
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<Affiliation>Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX.</Affiliation>
</AffiliationInfo>
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</AffiliationInfo>
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</AffiliationInfo>
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</AffiliationInfo>
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