Haematopoietic stem cell transplantation with non-myeloablative conditioning in the outpatient setting: results, complications and admission requirements in a single institution |
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Authors: | Petersen Søren L Madsen Hans O Ryder Lars P Svejgaard Arne Jakobsen Bodil K Sengeløv Henrik Heilmann Carsten Dickmeiss Ebbe Vindeløv Lars L |
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Affiliation: | The Lymphocyte Research Laboratory, Department of Haematology L 4041, Rigshospitalet, Blegdamsvej 8, DK-2100 Copenhagen, Denmark. slykkep@rh.dk |
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Abstract: | Thirty patients with haematological malignancies received peripheral blood stem cells from human leucocyte antigen (HLA)-identical sibling donors after non-myeloablative conditioning with fludarabine and total body irradiation. Twenty-seven patients received the transplant as an outpatient procedure. All patients engrafted. The probability of acute graft-versus-host disease (GVHD) grades II-IV and extensive chronic GVHD was 57% and 80%, respectively. Patients alive on day +365 experienced a median of 44 d (range 4-151) of hospitalization during the first year. In the entire cohort, GVHD accounted for 22%, infections for 18%, thrombotic thrombocytopenic purpura (TTP) for 16% and engraftment syndrome for 14% of the time in hospital. The 1-year risk of TTP was 26%. Acute GVHD was a risk factor for the development of TTP (P = 0.008). With a median follow-up of 602 d, the 2-year estimates for overall survival, progression-free survival, non-relapse mortality and relapse related mortality were 68%, 43%, 22% and 13%, respectively. This transplantation regimen is feasible and induces long-term remissions in heavily pretreated patients. The procedure can be performed in the outpatient setting, but complications could result in a substantial number of admissions during the first year. |
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Keywords: | non-myeloablative conditioning stem cell transplantation admission requirements thrombotic thrombocytopenic purpura human leucocyte antigen-identical donor |
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