Haematopoietic cell transplantation with non-myeloablative conditioning in Denmark: disease-specific outcome, complications and hospitalization requirements of the first 100 transplants

• Published in: Bone marrow transplantation (Basingstoke) Vol. 41; no. 10; pp. 851 - 859
• Main Authors: KORNBLIT, B, MASMAS, T, PETERSEN, S. L, VINDELØV, L, MADSEN, H. O, RYDER, L. P, SVEJGAARD, A, JAKOBSEN, B, SENGELØV, H, OLESEN, G, HEILMANN, C, DICKMEISS, E
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01.05.2008
• Subjects: Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Bone marrow; Bone marrow, stem cells transplantation. Graft versus host reaction; Chronic lymphocytic leukemia; Complications; Conditioning; Denmark - epidemiology; Female; Fludarabine; Graft versus host reaction; Graft vs Host Disease - epidemiology; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic Stem Cell Transplantation - methods; Hematopoietic stem cells; Hodgkin Disease - therapy; Hospitalization; Hospitalization - statistics & numerical data; Humans; Immunosuppression; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - therapy; Leukemia, Myeloid, Acute - therapy; Lymphoma; Lymphoma, Non-Hodgkin - therapy; Male; Medical sciences; Middle Aged; Mortality; Multiple myeloma; Multiple Myeloma - therapy; Myelodysplastic syndrome; Myelodysplastic syndromes; Myelodysplastic Syndromes - therapy; Non-Hodgkin's lymphoma; Outpatient care facilities; Outpatient Clinics, Hospital - utilization; Patient outcomes; Patients; Prevention; Risk factors; Stem cell transplantation; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplantation Conditioning - adverse effects; Transplantation Conditioning - methods; Transplants; Transplants & implants; Treatment Outcome; Vidarabine - analogs & derivatives; Vidarabine - therapeutic use; Whole-Body Irradiation; Denmark; Europe; Prognosis; admission requirements; Hematology; Hematopoietic cell; Complication; Graft; Hospitalization; Non myeloablative treatment; haematopoietic cell transplantation; non-myeloablative conditioning; outcome
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/bmt.2008.10

We analysed the outcome and hospitalization requirements of the first 100 patients (Hodgkin's disease (HD), N=13; multiple myeloma (MM), N=14; CLL, N=12; non-Hodgkin's lymphoma (NHL), N=17; myelodysplastic syndrome (MDS), N=18; AML, N=24 and CML, N=2) treated in Denmark with haematopoietic cell transplantation after non-myeloablative conditioning with TBI 2 Gy+/-fludarabine. The cumulative incidence of acute GVHD grade II-IV and extensive chronic GVHD was 67 and 49%. After a median follow-up of 534 days, the overall survival, PFS, relapse-related mortality and treatment-related mortality were 59, 50, 25 and 17%, respectively. Patients with CLL, NHL, AML and MDS with <5% blasts at any time had a favourable outcome with a PFS of 61-71%. Patients with MM, HD and MDS and a history of > or =5% blasts had a less favourable outcome with a PFS of 19-38% (P=0.001). The cumulative incidence of discontinuation of immunosuppression was 37%. During the first and second year post transplant, patients experienced a mean of 41 and 13 outpatient clinic visits, and 53 and 16 days of hospitalization. Sixteen patients were admitted to the intensive care unit, of whom eight are still alive. In conclusion, transplantation outcomes were encouraging, but complications requiring admission and outpatient clinic visits occur frequently post transplant.