Reduced BUCY 2 and G-CSF-primed bone marrow associates with low graft-versus-host-disease and transplant-related mortality in allogeneic HSCT

Abstract

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the ideal treatment for several diseases. However, the morbidity and mortality associated with the procedure might limit its widespread use; therefore, we implemented reduced BUCY2 as conditioning method along with the use of G-CSF-primed bone marrow (G-BM) in order to reduce complications, including graft-versus-host-disease (GVHD), and to improve survival in these patients. An analysis of transplant characteristics, complications, and survival of patients undergoing an allo-HSCT using this conditioning regimen (busulfan 12 mg/kg and cyclophosphamide 80 mg/kg) plus G-BM was performed. Forty patients were included from 1999 to 2015. All of them had a HLA-matched donor, with a median age of 32 years (range 16-59), and 55% were male. The most frequent diagnosis was myelodysplastic syndrome (MDS) in 14 patients (35%), followed by acute lymphoid leukemia (ALL) in 12 (30%). The mean of CD34+ was 2.09 × 106/kg. The mean time to neutrophil and platelet recovery was 20 and 18 days, respectively. The most common toxicity was mucositis (75%) with grade III-IV in 53% of cases. Acute GVHD appeared in 12.5 and 35% of patients developed chronic GVHD. Transplant-related mortality (TRM) was 10%. Five-year relapse-free survival was 69%, and the 5-year overall survival was 69.5%. Our conditioning method along with G-BM preserves an immunosuppressive and myeloablative effect allowing eradication of the malignant clone and achieving adequate bone marrow engraftment with acceptable toxicity, low incidence of GVHD, and low TRM, representing a favorable alternative for allo-HSCT.

Infections after hematopoietic cell transplantation are not a burden for mortality at a limited‐resource center in a developing country

“… c Most patients with malignant hematological disorders undergoing an allogeneic HCT received reduced BUCY2 (busulfan 12 mg/kg, ORAL and cyclophosphamide 80 mg/kg, IV) 30 …”

Association of Outcomes and Socioeconomic Status in Mexican Patients Undergoing Allogeneic Stem Cell Transplantation

“…Most patients with hematologic malignancies received reduced BUCY2 (busulfan 12 mg/kg orally and cyclophosphamide 80 mg/kg i.v.) [6], a reduced-intensity conditioning regimen developed at our center, and the rest received another myeloablative conditioning regimen. Patients with aplastic anemia received a cyclophosphamide-based conditioning regimen and/or antithymocyte globulin.…”

Oral Cyclosporine as an Alternative for Initial Standard Prophylaxis in Allogeneic Stem Cell Transplantation When Intravenous Formulation Is Unavailable

“…Further, the median age in our cohort was relatively low (68% ≤40 years), a fact that could have contributed to our overall favorable results, along with 94% of patients having an HLA-identical sibling donor. Furthermore, the low incidence of aGVHD in both groups could have been related with the use of bone marrow as the source of the HSCT, along with the dosage reduction of our most frequently used myeloablative conditioning regimen (71% reduced BUCY 2) [11], which could have reduced tissue damage, one of the proposed mechanisms that initiate GVHD. Although patients receiving ATG as part of their conditioning regimen had a lower frequency of both acute and chronic GVHD, no statistical significant differences were observed.…”