Late Gastrointestinal Complications of Allogeneic Hematopoietic Stem Cell Transplantation

Abstract

mg/kg/day on days-3 and-2) and TBI (2 Gy on day-1). GVHD prophylaxis consisted of Cy (50 mg/kg/day on days 3 and 4), tacrolimus (days 5 to 180), and mycophenolate mofetil (days 5 to 60). Our primary endpoint was the incidence of nonrelapse mortality (NRM) at day 100. Secondary endpoints included overall survival (OS), disease-free survival (DFS), the incidence of engraftment, acute GVHD, and relapse. Results: Median age was 48 (range 21-65) with 22 male and 9 female. Diagnosis of the patients included AML (n¼17), ALL/LBL (n¼8), MDS/MPN (n¼4), and lymphoma (n¼2). The majority (61.3%) of patients were not in remission and 13 patients (41.9%) had a history of prior allogeneic stem cell transplantation (allo-SCT). Twenty-seven patients (87.1%) engrafted with median neutrophil engraftment on 19 days (range 15-27). The cumulative incidence of grades II-IV and III-IV acute GVHD at day 100 was 22.6% (95% CI, 9.8-38.6%) and 3.2% (95% CI, 0.2-14.4%), respectively. NRM at day 100 was 19.4% (95% CI, 7.7-34.9%). Cumulative incidence of relapse at day 100 was 19.4% (95% CI, 7.7-35.0%). With a median follow-up of 171 days, OS and DFS was 74.2% (95% CI, 55.0-86.2%) and 61.3% (95% CI, 42.0-75.8%), respectively, at day 100. Subgroup analysis showed that patients who had a history of prior allo-SCT had higher NRM (30.8% vs. 11.1%, p¼0.07) and less lower OS (53.8% vs. 83.9%, p¼0.03) than those in patients without a history of prior allo-SCT. Conclusions: Our results suggest that posttransplant Cy based HLA-haploidentical PBSCT after busulfan containing reduced-intensity conditioning achieves stable donor engraftment and low incidence of GVHD. NRM was acceptable in the setting of the first allo-SCT. Given the promising results of GVHD and NRM, phase II study in much larger scale are now under investigation.