Feasibility of allogeneic hematopoietic stem cell transplantation using reduced-intensity conditioning with fludarabine and melphalan in patients relapsed after autologous hematopoietic stem cell transplantation

Abstract

The current study was performed to determine the feasibility of allogeneic hematopoietic stem cell transplantation (HSCT) using reduced-intensity conditioning (RIC) with fludarabine and melphalan in patients relapsed after autologous HSCT. Twelve patients (multiple myeloma n=7, non-Hodgkin’s lymphoma n=3, acute myeloid leukemia n=2) received allogeneic HSCT using the RIC with fludarabine (25mg/m2 for 5days) and melphalan (140mg/m2 for 1day) for relapsed disease after a prior autologous HSCT. The graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporine plus a mini-dose of methotrexate. All patients achieved a neutrophil or platelet engraftment in a median of 13.5 days and 17.5 days, respectively. The transplant-related mortality was 2 patients (16.7%). Grade II~IV acute GVHD and chronic extensive GVHD was noted in 4 (33.3%) and 1 patient (11.1%), respectively. Over a median follow-up duration of 12.5 months, 5 patients are currently alive without evidence of disease. The estimated non-relapse mortality (NRM) at 1 year was 28.4%. The estimated overall survival (OS) rate at 1 year 2was 58.3% and the estimated event-free survival (EFS) rate at 1 year was 41.7%. Allogeneic HSCT using RIC with fludarabine and melphalan appears to be feasible for a second HSCT in patients relapsed after autologous HSCT.