%0 Journal Article
%T Incidence and Pattern of Graft-versus-Host Disease in Patients Undergoing Allogeneic Transplantation after Nonmyeloablative Conditioning with Total Lymphoid Irradiation and Antithymocyte Globulin
%A Lauren Veltri
%A Michael Regier
%A Aaron Cumpston
%A Sonia Leadmon
%A William Tse
%A Michael Craig
%A Mehdi Hamadani
%J Bone Marrow Research
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/414959
%X Nonmyeloablative (NMA) conditioning with total lymphoid irradiation and antithymocyte globulin (TLI/ATG) has been shown to protect against acute graft-versus-host disease (GVHD). We report here our institutional experience with allogeneic transplantation following NMA conditioning with TLI/ATG ( ). GVHD prophylaxis consisted of a combination of a calcineurin inhibitor and mycophenolate mofetil. Median patient age was 59 years. The median followup of surviving patients is 545 days. One patient experienced primary graft rejection. The median time to neutrophil engraftment was 18 days and platelet engraftment was 9.5 days. The cumulative incidence (CI) of grade II¨CIV acute GVHD at day +100 was 28.6% and 38.1% at day +180. The CI for grade III-IV acute GVHD was 28.6% at day +180. CI of chronic GVHD was 45.2% at 1 year. The CI of disease relapse was 9.5% at 1 year. The rate of nonrelapse mortality (NRM) was 0% at day +100 and only 9.5% at 1 year. The overall and progression free survival at 1 year was 81% and 80.4%, respectively. Our limited, retrospective data show encouraging relapse and NRM rates with TLI/ATG-based NMA conditioning, but with higher than previously reported rates of acute and chronic GVHD, underscoring the need for novel strategies designed to effectively prevent GVHD. 1. Introduction Allogeneic hematopoietic cell transplantation (HCT) is a potentially curative modality for a variety of hematological malignancies [1, 2]. However, the high rates of procedure-related toxicities and nonrelapse mortality (NRM) have limited the applicability of HCT following conventional myeloablative conditioning regimens, to select cohort of younger patients with few or no comorbidities [3¨C8]. Hematological malignancies disproportionately affect the elderly [3]. From 2010 to 2030, the percentage of all cancers diagnosed in older adults in the United States will increase from 61% to 70% [9]. This change in demographics places an even greater emphasis on creating less toxic conditioning regimens, suitable for elderly or less fit individuals. The introduction of nonmyeloablative (NMA) and reduced-intensity conditioning (RIC) regimens has extended the use of allogeneic HCT to patients otherwise ineligible for conventional myeloablative HCT due to age or comorbidities [3, 10]. However, even with the decline in transplant-related toxicities with the introduction of NMA regimens, graft-versus-host disease (GVHD) remains a major cause of morbidity and mortality [11¨C16]. NMA conditioning with total lymphoid irradiation (TLI) and antithymocyte globulin (ATG) has been
%U http://www.hindawi.com/journals/bmr/2013/414959/