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Allogeneic haemopoietic stem cell transplantation using non-myeloablative conditioning--a local experience
C F Leong1, S K Cheong, S A Fadilah
1Clinical Haematology and Stem Cell Transplantation Services, MAKNA-HUKM Cancer Institute, Universiti Kebangsaan Malaysia, Kuala Lumpur.
The Medical Journal of Malaysia
|October 23, 2003
Summary
Non-myeloablative allogeneic stem cell transplants utilize reduced-intensity preparative regimens. This approach shows promise for managing blood disorders with fewer complications and lower costs.
Area of Science:
- Hematology
- Oncology
- Immunology
Background:
- Allogeneic haemopoietic stem cell transplantation (HSCT) was initially used for malignancy treatment via supralethal chemotherapy/irradiation.
- The primary benefit of HSCT is now recognized as the immune-mediated graft-versus-malignancy effect, not just high-dose therapy.
- This understanding has shifted focus towards less intensive preparative regimens to facilitate engraftment and harness the graft-versus-malignancy response.
Purpose of the Study:
- To evaluate the efficacy and safety of non-myeloablative allogeneic peripheral blood stem cell transplantation (allo-PBSCT) using reduced-intensity preparative regimens.
- To assess engraftment, graft-versus-host disease, treatment outcomes, and cost-effectiveness compared to myeloablative regimens.
Main Methods:
- Conducted 10 cases of allo-PBSCT for aplastic anaemia, acute myeloid leukemia (AML), and chronic myeloid leukemia (CML) using Fludarabine with Cyclophosphamide or Busulphan.
- Monitored rapid recovery, neutropenia, thrombocytopenia, and engraftment via donor short tandem repeats analysis at days 30, 60, and 100.
- Assessed graft-versus-host disease, treatment mortality, relapses, and overall survival.
Main Results:
- Successful engraftment (partial or complete donor chimerism) observed in 70% of cases by day 30.
- No treatment mortality by day 100; graft-versus-host disease was generally limited.
- Two CML patients experienced graft failure (one re-transplanted); two AML patients relapsed and deceased. Others remain well.
Conclusions:
- Non-myeloablative allo-PBSCT with reduced-intensity preparative regimens is a promising strategy for blood disorders.
- This approach offers rapid recovery, limited toxicity, and is approximately 25% of the cost of myeloablative regimens.
- Further research is warranted to optimize this less intensive transplantation method for broader patient application.