Allogene stamceltransplantatie na niet-myeloablatieve conditionering: gunstige ervaringen bij 21 hoogrisicopatiënten met een hematologische maligniteit behandeld in het Universitair Medisch Centrum Utrecht

To describe the results of allogeneic stem cell transplantation after non-myeloablative conditioning in high-risk patients with a haematological malignancy.

Design

Prospective and descriptive.

Method

In the Utrecht University Medical Centre 21 patients in an advanced stage of various haematological malignancies were treated with allogeneic stem cell transplantation following non-myeloablative conditioning. The patients were either younger than 55 but unsuitable for standard allogeneic stem cell transplantation because of co-existing disease, or between the ages of 55 and 70, and they had to have either a HLA-identical donor relative or a donor in which there was only one mismatched antigen. They were treated with a combination of fludarabine and a low dose of total body irradiation, followed by the administration of an unmanipulated stem cell transplantate.

Results

Engraftment of the stem cells was rapid in all patients but one, and 9 patients already showed complete donor cell chimerism 4 weeks after the infusion of stem cells. A total of 12 patients ultimately became completely donor chimeric, one of whom had received donor leucocytes; 7 patients were still mixed chimeric, with > 80 donor cells. 13 patients developed acute ‘graft-versus-host disease’ (GVHD), but in 10 of these it was mild and transitory. After a median follow-up of 9 months, 5 patients (24) had died, 4 as a result of disease progression and one from a cause related to the transplantation.

Conclusion

Allogeneic stem cell transplantation following non-myeloablative conditioning is a convenient mode of therapy with a low mortality related to the transplantation. It is particularly suitable for the treatment of older patients at high risk with regard to their disease.