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Disease Benefits Harms 5-Year Survival Comments 100-Day Mortality Comments ALL 30-50% Depending on the type of donor (HLA-identical sibling vs unrelated donor) and time of transplant (CR1, CR2+) 14-38% Depending on timing of transplant (CR1, CR+, others) AML 30-60% Depending on the type of donor (HLA-identical sibling vs unrelated donor) and time of transplant (CR1, CR2+) 13-38% Depending on timing of transplant (CR1, CR+, others); HLA-identical sibling, 1-year TRM for early leukemia: 21%; for intermediate: 24%; for advanced leukemia: 36% CLL 38-46% Depending on age at transplant (<45 yrs vs >45 yrs) (HLA-identical sibling only) Currently not reported by/available from IBMTR CML 37-67% Depending on type of the donor and timing of transplant 15-29% Depending on the phase of the disease (chronic, accelerated, blast crisis) Hodgkin's disease Currently not reported by/available from IBMTR Currently not reported by/available from IBMTR MDS 20-55% Depending on the phase of the disease (RAEB/RAEB-t vs RA/RARS) 25% Myeloma 32% (at 4 years) From Alyea and Anderson [4]; currently not reported by/available from IBMTR 10-56% From Alyea and Anderson [4]; currently not reported by/available from IBMTR NHL Currently not reported by/available from IBMTR Currently not reported by/available from IBMTR
Disease No. of Patients ALL 59 AML 105 CLL 27 CML 114 HD 37 NHL 124 MDS 32 MM 105 Total 603¶
* Data from 23 full papers, 1 abstract, and 1 letter. Note that most publications reported on more than one disease. Includes patients with PLL. Includes patients with plasma cell leukemia and extramedullary plasmacytoma (n=1). Assumed that the report by Michallet et al [20] included different patients than those described by Garban et al. [26] ¶ Excludes 25 additional patients with unclassified acute leukemia, 2 with Waldenström's macroglobulinemia, and 1 with CMML.
Benefits Survival** 75% at 1-4 yrs (n=18) [11] 28% at 2 yrs (n=86, 95% CI, 20-39%) [15] 30% at 2 yrs (n=31) [10] 60% at 58 mos (n=14) [18] 53% at 24 mos (n=45) [19] 75% at 36 mos (n=16) [21] 31% at 2 yrs (n=76) [20] Complete response 44% (215/486) Harms Treatment-related 32% (130/406) mortality Acute GVHD 51% (232/454) Chronic GVHD 23% (99/435) Veno-occlusive disease 0.8% (1/37) Relapse 15% (50/330)
* The table represents a compilation of extractable data from 25 different studies that are heterogeneous with respect to population selection, pretransplant conditions, and conditioning regimens. Data should be interpreted with caution. ** Data from individual studies reporting survival beyond 1 yr.
AML ALL CML MDS NHL HD CLL MM Benefits Survival** NA at 4 yrs NA 89% (17/19) at 1 yr NA 100% (1/1) at 1 yr NA NA 33% CR 66% (41/62) 49% (27/55) 58% (42/72) 48% (10/21) 31% (32/103) 41% (16/39) 33% (9/27) 37% (38/103) Harms TRM 19% (10/52) 72% (29/40) 20% (13/64) 36% (5/14) 43% (32/75) 26% (9/35) 33% (8/24) 24% (24/98) Acute GVHD 36% (25/70) 36% (19/52) 60% (32/53) 54% (12/22) 50% (49/97) 57% (21/37) 68% (13/19) 59% (61/103) Chronic GVHD 23% (15/66) 24% (12/50) 29% (15/51) 31% (6/19) 12% (11/91) 41% (13/32) 32% (10/31) 18% (17/95) Veno-occlusive Disease 0% (0/6) 0% (0/2) 0% (0/27) 50% (1/2) 0% (0/38) 0% (0/10) 0% (0/2) 0% (0/50) Relapse 25% (13/52) 27% (11/40) 18% (12/65) 7% (1/15) 2% (1/41) 11% (3/27) 6.6% (1/15) 10% (8/76)
* This table represents a compilation of extractable data from 25 different studies; there is a considerable heterogeneity among studies reflected in population selection, pretransplant conditions, and variety of conditioning regimens. Caution is needed in interpreting these data since they likely do not reflect an accurate body of evidence in NM-allo-SCT. ** Data on survival from single reports.
Study Disease No. of Patients Sex Median Age (range) Comorbid Conditions Regimen Study Design HLA Type Comments Giralt[17]
1997
(updated
2001[15])AML/MDS 43 52 F, 34 M 52 (22-70) (56% older than 50 yrs) NR Flu/Ida or CDA/AraC or Flu/Mel 140 or 180 Prospective cohort/case series without historical control HLA-compatible siblings (n=39) or 1-antigen mismatched siblings (n=7); HLA (6/6) MUD (n=40); not specified according to disease All considered poor candidates for conventional allo-transplant; median of 3 previous treatments (range 0-8) CML 27 HD 4 NHL 9 2CDA/AraC (not used after 1997) ALL 3 Carella[24]
1998CML 2 1 F, 1 M 52 (50-55) NR Flu/Cy Prospective cohort/case series without historical control HLA-matched siblings HD 4 2 F, 2 M 30 (22-36) NHL 2 1 F, 1 M 33 (24-43) MDS (RAEB) 1 1 F 57 Kelemen[11]
1998CML 19 NA Not reported individually (21-51) NR DBM/AraC/Cy Prospective cohort/case series, no historical control HLA-identical siblings (n=19) 8 patients under age 30 Khouri[16]
1998CLL 8 8 M 59 (51-71) Yes Flu/Cy/cisplatin/
cytarabineProspective cohort/case series, no historical control HLA-identical siblings 13 patients older than age 50, 2 had elevated ALT levels 2° due to alcohol-induced liver toxicity, 1 had hepatitis C infections NHL (4 patients with Richter's syndrome) 7 3 F, 4 M 52 (45-58) Flu/Cy or cisplatin/Flu/cytarabine Slavin[8]
1998ALL 2 2 M 49 (12-46) NR Flu/Bu/anti-T-lymphocyte globulin Prospective cohort/case series without historical control Matched related donors (n=2) Included data on patients with nonhematologic malignancies but abstracted data only on those with hematologic malignancies AML 8 6 F, 2 M 26 (1-51) Matched related donors (n=8) CML 8 1 F, 7 M 37 (2-56) Matched related donors (n=8) NHL 2 2 M 49 (37-61) Matched related donors (n=2) MDS 1 1 M 41 Matched related donor MM 1 1 M 51 Matched related donor Childs[22]
1999CML 4 1 F, 3 M 59 (28-68) NR Cy/Flu Prospective cohort/case series without historical control Not specified according to disease; HLA identical (n=14) or single HLA locus mismatched sibling (n=1) Included data on patients with nonhematologic malignancies but abstracted data only on those with hematologic malignancies NHL 1 1 F 55l MDS 2 2 M 59 (58-60) MM (EMP) 1 1 F 34 Garban[26]
1999
abstract
(updated
2001[13])MM 12 NR 53.5 (45-61) PS </= 2 Bu/ATG/Flu Prospective cohort/case series without control group HLA-identical sibling Giralt[14]
1999
abstractMM 18 NR 50 (46-61) NR Flu/Mel Prospective cohort/case series without control group HLA-identical sibling (n=13); MUD (n=5) Sykes[12]
1999NHL 5 NR 32 (20-51) No Cy/ATG/TI Prospective cohort/case series without historical control Haploidentical-related donor sharing at least one HLA A, B or D allele on the mismatched haplotype Bornhauser[29]
2000ALL 1 1 F 52 Yes Bu/Flu Prospective cohort/case series with no control HLA-matched sibling AML 10 2 F, 8 M 53 (38-65) CLL 3 1 F, 2 M 41 (33-46) CML 4 1 F, 3 M 51 (25-61) HD 2 2 M 36 (35-37) NHL 1 1 F 59 Gomez-
Almaguer[25]
2000
(updated
Ruiz-
Arguelles
2001[37])AML 6 6 F, 9 M 43 (14-52) NR Bu/Cy/Flu Prospective cohort/case series, no historical control HLA-identical sibling 21 patients transplanted in outpatient setting, 1 with thalassemia (excluded from this analysis) MDS 1 39 CML 8 45 (24-61) McSweeney[7]
1999
(updated
2001[5])AML 11 4 F, 7 M 57 (36-63) Yes Low-dose TBI (n=44), 1 patient received Flu (30 mg/m2) in addition to low-dose TBI (which is now the standard treatment and appeared to reduce increased incidence of the graft failure seen with low-dose TBI only) Prospective cohort/case series without control group HLA-identical sibling 53% transplanted as outpatients; general eligibility criteria included those with "relative contraindication to standard allo-SCT" such as age >50 years (>60 for CML); CLL/NHL had to fail at least frontline treatment and MM had to be stage II/III (n=2) with chemo-resistant acute leukemia and aspergillosis (n=1) after induction chemotherapy CML 9 2 F, 7 M (40-71) No CLL 8 1 F, 7 M (46-67) No NHL 1 1 F 53 No HD 4 2 F, 2 M 45 (31-61) No ALL 1 1 M 60 Yes MM 8 4 F, 4 M 56 (46-63) No MDS 1 1 M 43 (36-72) Yes WF 2 2 M 55 (52-58) No Nagler[28]
2000NHL 19 4 F, 15 M 41 (13-62) NR Low-intensity Flu Prospective cohort/case series, no historical control HLA-matched sibling HD 4 4 M 31 (17-53) Spitzer[27]
2000ALL 1 NE 40 NR Cy/ATG/TI Prospective cohort/case series, no control group HLA genotypic ally (n=20) or phenotypic ally (n=1) matched donor transplant AML 3 38 (27-44) HD 4 33 (27-55) NHL 11 45 (22-62) CLL 2 53 (50-55) Elmaagacli[9]
2001ALL 2 3 F, 6 M NE Yes Bu/Flu/ATG Prospective cohort series with historical controls HLA-matched genotypic ally (n=7); partially HLA identical (n=2) Included data on myeloablative conditioning regimens but only data on nonmyeloablative regimens are included in this table; age and gender not reported separately by disease AML 1 CML 6 Lee[30]
2001NHL 6 1 F, 5 M 31 (22-56) Yes Bu/Flu/ATG/
methylprednisoneProspective cohort/case studies without historical controls NR HD 1 1 M 53 Michallet[20]
2001ALL 25 NR NR Yes Flu/Bu/ATG
Ida/Flu/AraC OAT/LGRetrospective case series analysis All HLA-identical sibling; 1 HLA-identical unrelated donor but not reported according to disease category Conditioning regimens and HLA types not reported separately by disease; 3 patients with solid tumors excluded from abstracting and analysis; data extracted on evaluable patients MDS 9 NHL 13 MM 11 HD 3 CLL 3 CML 12 Mohty[31]
2001NHL 3 1 F, 2 M 42 (26-47) Yes Bu/Flu Prospective cohort/case studies without historical control HLA-matched genotypic ally (n=10); partially HLA identical (n=1) One each of NHL, HD and CLL also received ATG as part of conditioning regimen HD 1 1 M 40 CLL 1 1 M 49 MM 6 3 F, 3 M 54 (47-62) Chakraverty[33]
2002MM 12 5 F, 7 M 47 (34-52) Yes CAMPATH1H/Flu/Mel Prospective cohort study without historical controls Not specified according to disease; all patients had MUD transplant Low-and high-grade lymphoma grouped as NHL NHL 15 5 F, 10 M 39 (18-56) CML 5 2 F, 3 M 48 (36-53) AML 6 4 F, 2 M 49 (30-55) ALL 2 1 F, 1 M 22 (18-27) HD 5 3 F, 2 M 31 (22-38) CLL (T-PLL) 1 1 F 50 CMML 1 1 M 62 Corradini[19]
2002AML 5 17 F, 28 M NE Yes Thiotepa/Cy/Flu Prospective cohort study without historical controls Not specified by disease; HLA-identical (n=42) or single HLA locus mismatched (n=3) sibling Indolent and high-grade lymphoma grouped as NHL MDS 6 ALL 1 NHL 24 HD 4 MM 5 Schlenk[34]
2002AML 9 3 F, 6 M 61 (30-64) Yes Flu/Cy/Ida/etoposide Prospective cohort study without historical control All HLA-identical sibling (n=11) ALL 1 1 M 57 CML 1 1 M 62 Nagler[21]
2001CML 7 1 F, 6 M 17 (12-48) Yes Flu/Bu/ATG Prospective cohort study without historical controls MUD (n=16) AML 4 2 F, 2 M 21 (18-27) ALL 4 4 M 10 (8-17) NHL 1 1 M 13 Pawson[18]
2001AML 7 5 F, 2 M 32 (24-48) Yes FLAG (n=2)
FLAG-Ida (n=4)
FLAG-X (n=1)Prospective cohort/case series with no historical control Full HLA-matched (n=13), 1-antigen-mismatched (n=1) ALL 5 5 M 18 (9-31) FLAG-Ida (n=4)
FLAG-X (n=1)MDS/(RAEB-t) 2 2 F 40 (38-42) FLAG-Ida Badros[10]
2002MM 31 13 F, 18 M 56 (38-69) Yes Mel/TBI/Flu Prospective cohort/case studies with historical controls HLA-matched sibling (n=25); MUD (n=6) Conditioning regimen for HLA-matched transplant differed from MUD transplant Baron[32]
2002ALL 1 1 M 25 No Flu/TBI Prospective cohort/case studies with no historical control MUD, identical Patients eligible for NM-allo-SCT if older than age 55 (n=4), had concurrent medical conditions (n=0), failed previous autograft (n=4), or had multiple factors (n=3); 2 with RCC excluded from abstraction; MUD or not heavily pretreated patients received TBI/Flu; Flu/Cyused if previously given >/= 12 Gy TBI AML 1 1 F 57 TBI HLA-matched sibling CLL 1 1 F 61 TBI HLA-matched sibling CML 2 1 F, 1 M 60 (58-62) TBI (n=1) Flu/TBI (n=1) HLA-matched sibling HD 1 1 M 22 TBI HLA-matched sibling
Table Abbreviations ALL=acute lymphocytic leukemia
AML=acute myelocytic leukemia
AraC=cytarabine
ATG=antithymocyte globulin
Bu=busulfan
BW=body weight
CDA=chloroadenosine
CLL=chronic lymphocytic leukemia
CML=chronic myelogenous leukemia
CMML=chronic myelomonocytic leukemia
CMV=cytomegalovirus
CR=complete remission
Cy=cyclophosphamide
d=days
DBM=dibromomannitol
DFS=disease-free survival
EMP=extramedullary plasmacytoma
FLAG=Flu/AraC/G-CSF
FLAG-Ida=FLAG with Ida
FLAG-X=FLAG with daunorubicin
Flu=fludarabine
GVHD=graft-vs-host diseaseHD=Hodgkin's disease
Ida=idarubicin
LCL=large-cell lymphoma
MDS=myelodysplastic syndrome
Mel=melphalan
MM=multiple myeloma
MUD=matched unrelated donor
NE=not extractable
NHL=non-Hodgkin's lymphoma
NR=not reported
NS=not stated
OAT/LG=other regimens with ATG or ALG
PFS=progression-free survival
PR=partial remission
PS=performance status
RAEB=refractory anemia with excess blasts
RAEB-t=RAEB in transformation
RCC=renal cell carcinoma
TBI=total body irradiation
TI=thymic irradiation
T-PLL=T-cell prolymphocytic leukemia
TRM=treatment-related mortality
WM=Waldenström macroglobulinemia
yr=year
Reference Disease Overall Survival at 1-5 Yrs Disease-Free Survival at 1-5 Yrs Median or Survival Range Complete Response Partial Response Mixed Chimerism Full Chimerism Comments Giralt[17]
1997
(updated
2001[15])AML 30% at 400 d 32% at 400 d NE NE NR Yes Yes 2-yr survival for all patients was 28% (95% CI, 20-39); 2-yr disease-free survival for all patients was 23% (95% CI, 15-34) MDS 30% at 400 d 32% at 400 d NE CML 40% at 400 d 40% at 400 d 70% (19/27) HD 20% at 400 d 20% at 400 d 25% (1/4) NHL 20% at 400 d 20% at 400 d 22% (2/9) ALL 20% at 400 d 20% at 400 d 33% (1/3) Carella[24]
1998CML NE NE 4 mos (2-10) 50% (1/2) 0% (0/2) Yes Yes No patients required sterile room or red cell/platelet transfusion HD NE 50% (2/4) 25% (1/4) NHL 4 mos (2-10) 50% (1/2) 50% (1/2) MDS 4 mos (2-10) 100% (1/1) 0% (0/1) Kelemen[11]
1998CML 89% at 4 yrs (17/19) 82% at 4 yrs (14/17) NE NR NR Yes Yes Chimerism investigated at 6 mos in 16 patients Khouri[16]
1998CLL NE NE NE 38% (3/8) 25% (2/8) Yes Yes 50% probability of survival at 1 yr for the whole group based on median follow-up of 180 days (range 90 to 767 days) NHL/LCL 71% (5/7) 14% (1/7) Slavin[8]
1998ALL NE NE NE NR NR Yes Yes No procedure-related deaths reported; survival for whole group at >1 yr was 85% (22/26); 21% disease free, included patients with nonmalignant hematologicdisease AML CML NHL MDS MM Childs[22]
1999CML NE NE 206 d (106-379) 75% (3/4) NE Yes Yes NHL 220 d 100% (1/1) MDS 226 d (205-248) 0% (0/2) MM 121 d 0% (0/1) Garban[26]
1999
(updated
2001[13])MM NE NE >6 - >15 mos 33% (4/12) 58% (7/12) Yes Yes Giralt[14]
1999MM 33% at 1 yr 30% at 1 yr 194 d (0-582) 47% (8/18) NE Yes Yes Sykes[12]
1999NHL 0% at 1 yr (1/5) NE 20% (1/5) 20% (1/5) 20% (1/5) Yes Yes Bornhauser[29]
2000ALL NE NE NE 100% (1/1) 0% (0/1) Yes Yes 100-day survival was 95% for the whole group AML 80% (8/10) NE CLL 67% (2/3) 33% (1/3) CML 100% (4/4) 0% (0/4) HD NE 50% (1/2) NHL NE NE Gomez-
Almaguer[25]
(updated
Ruiz-
Arguelles,
2001[37])AML NE NE 60-360 d (4/6 alive) 60% (4/6) NR Yes Yes Median survival for all patients was 249 days; 1 graft failure reported MDS 90 d (1 died) NR CML 60-360 d (4/8 alive) 50% (4/8) ALL 30-300 d (5/10 alive) 50% (5/10) McSweeney[7]
1999
(updated
2001[5])AML NE NE 2- > 15 mos 64% (7/11) 0% (0/11) Yes Yes Median follow-up for whole group was 417 days (320-769 days); overall survival for all patients was 67% (30/45); 20% (9/44) rejected graft between 2 and 4 mos; no fatal rejections; overall TRM was 7% (3/45); relapse-related mortality was 27%; full chimerism in 21 patients by day 56 CML 6- > 12 mos 56% (5/9) 0% (0/9) CLL 4- > 12 mos 38% (3/8) 38% (3/8) NHL 2 mos (died) 100% (1/1) NA HD 4- > 10 mos 50% (2/4) 0% (0/4) ALL 11 mos 100% (1/1) NA MM 2- > 24 mos 50% (4/8) 38% (3/8) MDS 6 mos (died) 0% (0/1) 0% (0/1) WM 11- > 12 mos 0% (0/2) 0% (0/2) Nagler[28]
2000NHL NE NE NE NE NE Yes Yes HD Spitzer[27]
2000ALL NE NE NE 0% (0/1) 0% (0/1) Yes Yes AML 33% (1/3) 33% (1/3) HD 50% (2/4) 25% (1/4) NHL 36% (4/11) 27% (3/11) CLL 50% (1/2) 50% (1/2) Elmaagacli[9]
2001ALL NE NE NE NE NE Yes Yes Survival/DFS/CR/PR not reported by disease: Survival at 1 and 2 yrs in the group receiving reduced conditioning regimen compared to conventional BMT was 77% and 74%, respectively AML CML Lee[30]
2001NHL NR NR NR 33% (2/6) 0% (0/6) Yes No Survival not reported according to disease group HD 0% (0/1) 100% (1/1) Michallet[20]
2001ALL NE NR NE 36% (9/25) 16% (4/25) Yes Yes Survival not reported by disease; overall survival was 38% at 1 yr and 31% at 2 yrs MDS 22% (2/9) 11% (1/9) NHL 8% (1/13) 85% (11/13) MM 0% (0/11) 54% (6/11) HD 42% (5/12) 0% (0/12) CLL 0% (0/3) 33% (1/3) CML 0% (0/3) 67% (2/3) Mohty[31]
2001NHL NR NR NR 33% (1/3) 33% (1/3) Yes Yes HD 100% (1/1) 0% (0 /1) CLL 0% (0/1) 0% (0/1) MM 33% (2/6) 0% (0/6) Chakraverty[33]
2002MM NE NE NE 0% (0/12) 45% (5/12) Yes Yes Survival or DFS not reported by disease; at 1 yr, overall was 76% and PFS was 62% NHL 47% (7/15) 7% (1/15) CML 100% (5/5) 0% (0/5) AML 67% (4/6) 0% (0/6) ALL 50% (1/2) 0% (0/2) HD 40% (2/5) 0% (0/5) CLL (T-PLL) 0% (0/1) 0% (0/1) CMML 100% (1/1) 0% (0/1) Corradini[19]
2002AML NE NE NE 60% (3/5) 0% (0/5) Yes Yes Survival not reported by disease; overall survival at 2 yrs was 53%; progression-free survival at 20 mos was 57% MDS 83% (5/6) 0% (0/6) ALL 100% (1/1) 0% (0/1) NHL 67% (16/24) 25% (6/24) HD 25% (1/4) 0% (0/4) MM 20% (1/5) 60% (3/5) Schlenk[34]
2002AML NR NR NR 67% (6/9) 0% (0/9) Yes No Survival not reported by disease; overall survival at 22 mos was 44% ALL 100% (1/1) 0% (0/1) CML 0% (0/1) 0% (0/1) Nagler[21]
2001CML NE NE NE 0% (0/7) 14% (1/7) Yes Yes Survival/DFS not reported by disease; actuarial survival and DFS at 36 mos were 75% and 60%, respectively; alive and continuously disease-free were considered CR in this analysis; alive and well were considered PR AML 25% (1/4) 50% (2/4) ALL 25% (1/4) 50% (2/4) NHL 0% (0/1) 100% (1/1) AML 25% (1/4) 50% (2/4) Pawson[18]
2001AML NE NE NE 86% (6/7) 14% (1/7) Yes Yes Survival and DFS not reported by disease; overall survival was 75% at 1 yr and 62% at 2, 3, 4, and 5 yrs; DFS was 63% at 1 yr, 38% at 2 yrs, and 26% at 3, 4, and 5 yrs ALL 100% (5/5) 0% (0/5) MDS (RAEB-t) 100% (2/2) 0% (0/2) Badros[10]
2002MM 1 yr: 68%
2 yrs: 30%NR NE 61% (19/31) 10% (3/31) Yes Yes Median survival was 15 mos; projected actuarial survival at 1 yr was 71% and 31% at 2 yrs; survival at 1 yr posttransplant was 71% for mini allograft compared to 45% for historical controls with conventional allo-SCT Baron[32]
2002NHL NE NE NE 100% (5/5) 0% (0/5) Yes Yes Survival not reported by disease; overall survival at 1 yr was 69% CML 50% (1/2) 0% (0/2) CLL 0% (0/1) 100% (1/1) AML 100% (1/1) 0% (0/1) ALL 100% (1/1) 0% (0/1)
Reference Disease Transplant-Related Mortality Acute GVHD Chronic GVHD Veno-Occlusive Disease Relapse Other Toxicity (Grade III-IV) and Comments Giralt[17]
1997
(updated
2001[15])AML 43% (16/43) 49% (95% CI 38-60) 68% ± 9% (21/46) NR 27% (23/86) Nonrelapse mortality at 2 yrs was ~45% MDS 60% (34/76) NE NE CML 25% (7/27) NE HD 75% (3/4) NHL 78% (7/9) ALL 67% (2/3) Carella[24]
1998CML 0% (0/2) 50% (1/2) NR NR NR No severe procedure-related toxicity HD 25% (1/4) 50% (2/4) NHL 0% (0/2) 0% (0/2) MDS (RAEB) 0% (0/1) 0% (0/1) Kelemen[11]
1998CML 11% (2/19) 11% (2/18) 67% (12/18) 0% (0/18) 33% (6/18) 6% (1/18); not explicitly stated but estimated from Table 1 and comments in the text Khouri[16]
1998CLL 38% (3/8) NE 13% (1/8) NR NE Toxicity NE; acute GVHD occurred after initial transplantation in 5 patients; not specified according to disease NHL 43% (3/7) 14% (1/7) Slavin[8]
1998ALL 0% (0/2) NE 50% (1/2) NE 50% (1/2) Differences noted in reporting on GVHD between text and Table 3; data extracted from Table 3 AML 25% (2/8) 38% (3/8) 13% (1/8) 13% (1/8) CML 25% (2/8) 50% (4/8) 13% (1/8) 0% (0/8) NHL 0% (0/2) NE 50% (1/2) 0% (0/2) MDS 0% (0/1) NE NS 0% (0/1) MM 0% (0/1) NE NS 0% (0/1) Childs[22]
1999CML NE 50% (2/4) 25% (1/4) 0% (0/4) 0% (0/4) 2 patients died of transplant-related causes (1 had melanoma) NHL 100% (1/1) 0% (0/1) 0% (0/1) 0% (0/1) MDS 50% (1/2) 0% (1/2) 50% (1/2) 0% (0/2) MM 0% (0/1) 0% (0/1) 0% (0/1) 100% (1/1) Garban[26]
1999
(updated
2001[13])MM 17% (2/12) 50% (6/12) 58% (7/12) (2 extensive) NR 8% (1/12) 5 of 11 patients developed CMV infection (1 died of CMV encephalitis) Giralt[14]
1999MM 47% (8/17) 52% (9/17) 18% (3/17) NR NR Sykes[12]
1999NHL 40% (2/5) 100% (5/5) 0% (1/5) NR 20% (1/5) Bornhauser[29]
2000ALL NE 100% (1/1) 0% (0/1) NE NE 100% (1/1) AML 10% (1/10) 40% (4/10) 50% (5/10) 30% (3/10) 10% (1/10) CLL NE 67% (2/3) 33% (1/3) 0% (0/3) 33% (1/3) CML 75% (3/4) 25% (1/4) 50% (2/4) 0% (0/4) HD 50% (1/2) 0% (0/2) 100% (2/2) 50% (1/2) NHL 100% (1/1) 0% (0/1) NE 0% (0/1) Gomez-
Almaguer[25]
2000
(updated
Ruiz-
Arguelles,
2001[37])ALL NE 30% (3/10) 29% (2/7) NE 60% (3/5) TRM was 12% (3/25) for all patients; each died of acute GVHD AML 0% (0/6) 0% (0/5) 50% (2/4) CML 62% (5/8) 63% (5/8) 75% (3/4) MDS 100% (1/1) 100% (1/1) 0% (0/1) McSweeney[7]
2000
(updated
2001[5])AML 0% (0/11) 36% (4/11) 45% (5/11) NR % (1/11) Toxicity was mild; none experienced mucositis, severe nausea and vomiting, pulmonary toxicity, cardiac toxicity, hemorrhagic cystitis, or new-onset alopecia; 3 of 45 patients (7%) died CML 0% (0/9) 67% (6/9) 44% (4/9) 0% (0/9) CLL 13% (1/8) 63% (5/8) 75% (6/8) 0% (0/8) NHL 100% (1/1) 100% (1/1) NR 0% (0/1) ALL 0% (0/1) 100% (1/1) 0% (0/1) 0% (0/1) MM 13% (1/8) 50% (4/8) 17% (1/6) 13% (1/8) HD 0% (0/4) 75% (3/4) 50% (2/4) 0% (0/4) MDS 0% (0/1) 0% (0/1) NR 0% (0/1) WM 0% (0/2) 50% (1/2) 100% (2/2) 1 extensive 0% (0/2) stable disease Nagler[28]
2000NHL NE NE NE 0% (0/19) NE 7 patients died (4 of grade III-IV GVHD and severe infections, 2 of bacterial sepsis, 1 of pulmonary failure) HD 0% (0/4) Spitzer[27]
2000ALL 0% (0/1) 0% (0/1) NE NE NE NE AML 33% (1/3) 67% (2/3) CLL 0% (0/2) 100% (2/2) HD 0% (0/4) 100% (4/4) NHL 9% (1/11) 36% (4/11) 9% (1/11) Elmaagacli[9]
2001ALL NE NE NE NE NE NE AML CML Lee[30]
2001NHL 100% (6/6) 50% (3/6) 17% (1/6) NR NE NR HD 100% (1/1) 100% (1/1) 100% (1/1) Michallet[20]
2001ALL 96% (24/25) 24% (6/25) 24% (6/25) NR 16% (4/25) NE MDS 44% (4/9) 44% (4/9) 22% (2/9) 11% (1/9) NHL 54% (7/13) 62% (8/13) 8% (1/13) 0% (0/13) MM 55% (6/11) 72% (8/11) 27% (3/11) 37% (4/11) HD 17% (2/12) 42% (5/12) 42% (5/12) 0% (0/12) CLL 67% (2/3) 67% (2/3) 0% (0/3) 0% (0/3) CML 0% (0/3) 33% (1/3) 33% (1/3) 0% (0/3) Mohty[31]
2001NHL 67% (2/3) 0% (0/3) NR 0% (0/3) NR All patients survived beyond day 30 and maintained good oral intake throughout the procedure HD 100% (1/1) 100% (1/1) 0% (0/1) CLL 100% (1/1) 100% (1/1) 0% (0/1) MM 33% (2/6) 100% (6/6) 0% (0/6) Chakraverty[33]
2002MM 17% (2/12) 50% (6/12) 0% (0/12) 0% (0/12) 8% (1/12) NR NHL 47% (6/15) 27% (4/15) 0% (0/15) 0% (0/15) 0% (0/15) CML 0% (0/5) 60% (3/5) 20% (1/5) 0% (0/5) 0% (0/5) AML 17% (1/6) 33% (2/6) 17% (1/6) 0% (0/6) 17% (1/6) ALL 50% (1/2) 0% (0/2) 0% (0/2) 0% (0/2) 0% (0/2) HD 20% (1/5) 40% (2/5) 20% (1/5) 0% (0/5) 20% (1/5) T-PLL (CLL) 0% (0/1) 0% (0/1) 0% (0/1) 0% (0/1) 100% (1/1) CMML 0% (0/1) 0% (0/1) 0% (0/1) 0% (0/1) 0% (0/1) Corradini[19]
2002AML NE 40% (2/5) 40% (2/5) NR NE NR MDS 83% (5/6) 17% (1/6) ALL 100% (1/1) 0% (0/1) NHL 75% (18/24) 42% (10/24) HD 50% (2/4) 75% (3/4) MM 80% (4/5) 40% (2/5) Schlenk[34]
2002AML 4% (4/9) 22% (2/9) 0% (0/9) NR 44% (4/9) 11% (1/9) ALL 0% (0/1) 0% (0/1) 0% (0/1) 100% (1/1) 0% (0/1) CML 100% (1/1) 100% (1/1) 100% (1/1) 100% (1/1) 0% (0/1) Nagler[21]
2001CML 67% (2/7) 86% (6/7) 0% (0/7) NR 0% (0/7) 14% (1/7) AML 25% (1/4) 100% (4/4) 0% (0/4) 25% (1/4) 25% (1/4) ALL 25% (1/4) 100% (4/4) 0% (0/4) 50% (2/4) 0% (0/4) NHL 0% (0/1) 100% (1/1) 0% (0/1) 0% (0/1) 0% (0/1) Pawson[18]
2001AML NE 29% (2/7) 0% (0/7) NR NE Relapse not reported by disease but 10 of 14 patients relapsed ALL 60% (3/5) 60% (3/5) MDS (RAEB-t) 50% (1/2) 50% (1/2) Badros[10]
2002MM 10% (3/31) 58% (18/31) 32% (10/31) 0% (0/31) 0% (0/31) TRM in mini-allograft group was 10% (3/31) vs 29% (27/93) in standard allo-SCT group Baron[32]
2002NHL 20% (1/5) 60% (3/5) 80% (4/5) NR NR NR CML 50% (1/2) 0% (0/2) 0% (0/2) CLL 100% (1/1) 100% (1/1) 0% (0/1) AML 0% (0/1) 0% (0/1) 00% (1/1) ALL 100% (1/1) 0% (0/1) 0% (0/1)
Author Comorbid Condition Reasons for Consideration of NM-allo-SCT vs Standard HLA MUD Graft Failure Comments Giralt[17]
1997
(update
2001[15])Concurrent medical conditions were also eligible Patients considered poor candidates for conventional allotransplant because of age (> 50 yrs) or concurrent medical conditions HLA-compatible siblings 6/6 (n=39); one-antigen-mismatched siblings 5/6 (n=7) n=40 (6/6) n=1 (autologous reconstitution) All 17 patients who entered remission had 100% donor cells at 1 yr Carella[24]
1998NS (no general contraindication to stem cells transplantation) First-and second-line therapy without success (HD=4; NHL=2); CML in accelerated phase (n=1); CML in myeloblastic transformation with 70% marrow blasts (n=1); refractory anemia with excess blasts (n=1) HLA-matched siblings (n=9) n=0 n=0 Evidence of 100% donor cell engraftment in 6 patients Kelemen[11]
1998NS NS HLA-identical siblings (n=19) n=0 n=0 Khouri[16]
1998Patients were eligible if >50 yrs or had other medical problems that would preclude the administration of high dose; elevated ALT secondary to alcohol-induced liver toxicity (n=2); history of active hepatitis C (n=1); performance status of 3 (n=4) Patients ineligible for high-dose ablative preoperative regimens due to age >50 yrs (n=13) or comorbidities HLA-identical siblings (n=15) n=0 n=0 Slavin[8]
1998NS 26 patients with standard indications for allogeneic BMT; NS HLA-matched related donors (n=22) n=0 n=0 Childs[22]
1999NS Eligibility criteria for hematologic malignancies included disease with a probability of slow progression or in remission in patients >55 yrs HLA-identical siblings (n=8) n=0 n=0 One patient rejected transplant with subsequent recovery of autologous hematopoiesis Garban[26]
1999
(update
2001[13])NS Poor candidates to conventional allogeneic transplantation with high-risk or relapsing myeloma patients HLA-identical siblings (n=12) n=0 n=0 Giralt[14]
1999NS Patients having failed prior auto SCT (n=7) HLA-identical siblings (n=13) n=5 n=0 8 patients were <30 yrs of age Sykes[12]
1999Eligibility criteria: chemotherapy-refractory NHL, performance status 2 or less; age 65 yrs or younger, and adequate organ function Chemotherapy-refractory NHL performance status 2 or less, age 65 yrs or less, and adequate organ function Haploidentical-related donor sharing at least 1 HLA A, B, or D allele on the mismatch haplotype n=0 n=0 Bornhauser[29]
2000NS according to patients and disease Patients with reduced performance status or major infectious complications not eligible for standard transplant procedure HLA-matched siblings (n=21) n=0 n=0 Gomez-
Almaguer[25]
2000
(update
Ruiz-
Arguelles
2001[37])NS NS HLA-identical siblings in all instances 6/6 (n=25) n=0 n=1 Full chimerism (defined as more than 90% of donor cells on day 30 and afterwards) was seen in 17 patients, outpatients n=21 McSweeney
1999[7]
(update
2001[5])Preexisting liver cirrhosis (n=1), coronary artery disease, pulmonary aspergillosis, number of patients not specified Patients ineligible for conventional HCT because of age or medical contraindications CLL and lymphomas had failed at least front-line therapy (n=NS); resistant acute leukemia (n=3); preexisting liver cirrhosis (n=1) aspergillosis (n=1) HLA-identical siblings in all instances 6/6 (n=45) n=0 n=9 53% of eligible patients had entirely outpatient transplants; 9 patients subsequently rejected their grafts (between 2-4 mos); none of these patients died Nagler[28]
2000NS All patients were very high risk and heavily treated; of the 23 patients, 12 had resistant disease (primary refractory or resistant relapse) and 11 were in third partial relapse at treatment HLA-matched siblings (n=22) n=1 n=0 Spitzer[27]
2000NS Chemotherapy-refractory hematologic malignancies HLA genotypic ally (n=20) or phenotypic ally (n=1) matched-donor transplant n=0 n=0 Elmaagacli[9]
2001NS To assess the efficacy of NM-allo-SCT vs BMT HLA sibling (n=7); HLA partially matched family (n=2) n=0 n=0 Lee[30]
2001NS according to patients and disease To investigate the effectiveness of nonmyeloablative stem-cell transplantation for patients with heavily pretreated refractory lymphoma NR NR NE HLA type not reported in this study Michallet[20]
2001NS according to treatment and disease To assess the impact of pre-and post-transplantation factors on the outcome after nonmyeloablative preparative regimens HLA-identical sibling (n=78) n=0 NR Mohty[31]
2001NS NS HLA-identical sibling (n=11) n=0 n=0 Chakraverty[33]
2002NS To investigate the effectiveness of reduced-intensity conditioning regimen in patients undergoing transplant from matched unrelated donor n=0 n=47 NE Corradini[19]
2002NS according to disease To investigate the effectiveness of reduced-intensity conditioning regimen in patients considered as poor candidates for conventional myeloablative regimens HLA-identical (n=42) or single HLA locus-mismatched (n=3) siblings n=0 NE Schlenk[34]
2002NS according to patients and disease Assess toxicity and feasibility of achieving engraftment of allogenic blood progenitor cells following nonmyeloablative conditioning HLA-identical sibling (n=11) n=0 NR Nagler[21]
2001NS To investigate the feasibility of low intensity conditioning for BMT from matched unrelated donors n=0 n=16 n=0 Pawson[18]
2001NS To test the use of reduced intensity conditioning regimens to lessen transplant-related morbidity and mortality Full HLA match (n=13); one-antigen-mismatch (n=1) n=0 n=0 Badros[10]
2002NS To investigate the feasibility of low-intensity melphalan-based conditioning regimen HLA-identical siblings (n=25) n=6 n=0 Baron[32]
2002NS Patients were not eligible for standard SCT HLA siblings (n=7); HLA sibling one-mismatch (n=2) n=2 NR
Study Conditioning Regimen Doses Comments Flu Bu CY ATG TBI TI Mel Other Giralt[17]
199730 mg/m2 IV x 4 days Either Ara-C 2 g/m2 or Ia 12 mg/m2 x 3 days (IV) 1 patient received melphalan 140 mg/m2 once at the end of chemotherapy; 2/15 had grade III/IV toxicity 30 mg/m2 x 4 days IV Ara-C 1 g/m2 x 5 days and 2-CDA 12 mg/m2 (IV) 7 patients Carella[24]
199830 mg/m2 x 3 days 300 mg/m2 x 3 days No procedure-related deaths Kelemen[11]
1998150 mg/kg IV on days-4,-3,-2 DBM 120 mg/kg p. o. x 3 days, Ara-C IV 60 mg/kg x 3 days Remarkable reduction in certain transplant-related complication Khouri[16]
199830 mg/m2 IV x 3 days 300 mg/m2 IV x 3 days 5 CLL patients 30 mg/m2 IV x 5 days 1000 mg/m2 IV x 2 days 4 patients 30 mg/m2 IV x 2 days Cisplatin 25 mg/m2 IV x 2 days, cytarabine 500 mg/m2 x 2 days 4 patients with Richter's syndrome Slavin[8]
199830 mg/m2 IV x 6 days Oral 4 mg/kg x 2 days 10 mg/kg x 4 days No procedure-related deaths reported Childs[22]
199925 mg/m2 IV x 5 days 60 mg/kg IV x 2 days Garban[26]
1999
abstract25 mg/m2 x 5 days 2 mg/kg x 2 days 2.5 mg/kg Well-tolerated protocol, no mucositis; x 5 days duration of aplasia <7 days Giralt[14]
abstract
1999140 or 180 Flu/mel 140 or 180 was well tolerated with only 1 toxic death from tumor lysis and multiorgan failure Sykes[12]
199950 mg/kg 30 mg/kg 7 Gy on day-1 Bornhauser[29]
200030 mg/m2 IV x 5 days 3.3 mg/kg IV x 3 days TRM was 12.5% Gomez-
Almaguer[25]
2000
(update
Ruiz-
Arguelles
2001[37])30 mg/m2 IV x 3 days Oral 4 mg/kg x 2 days 350 mg/m2 IV x 3 days Showed that allogeneic stem cell transplantation can be performed safely on outpatient basis McSweeney 2000[7]
(update
2001[5])Low-dose TBI 2 Gy single fractional day-4 Toxicity was mild, no mucositis, and no nausea; almost no myelosuppression noted Nagler[28]
2000Low-intensity regimen 7 patients died (4 of grade III-IV GVHD and severe infections, 2 of bacterial sepsis, 1 pulmonary failure Spitzer[27]
200050 mg/kg IV on day-6 or -5 through-3 30 mg/kg x 2 days 7 Gy on day-1 Elmaagacli[9]
200130 mg/m2 IV x 4 days 1 mg/kg BW p. o. every 6 hrs over 2 days 10 mg/kg BW for 4 days Lee[30]
200130 mg/m2/d IV on days -7 to-2 4 mg/kg/d p. o. on days -7 and-6 20 mg/kg/d IV on days-5 to-2 Methylprednisolone 2 mg/kg/d IV on days-5 to-2 Michallet[20]
2001Dose varying from 25-30 mg/m2/d for 5 or 6 days 2 to 4 mg/kg/d for 2 days 2.5 mg/kg/d for 3, 4 or 5 days ALG 5 mg/kg/d for 4 or 5 days combined with TBI in 5 patients Ida 21 mg/m2/d days, cytarabine 2 g/m2/d for 4 days 3 different types of conditioning regimens were considered: FBT v IFA v ATG/ALG or regimens containing or not containing ATG/ALG: with ATG/ALG (FBT + ATG/ALG) and without ATG/ALG (IFA) Mohty[31]
200125 mg/m2 IV x 5 days 2 mg/kg BW p. o. over 2 days 2.5 mg/kg/d IV for 4 days ATG was administered to 3 patients only (NHL, HD, and CLL) Chakraverty[33]
200230 mg/m2/d IV on days-7 and-3 140 mg/m2 IV 30 min on day-2 CAMPATH-1H 20 mg/d IV on days-8 to-4 Corradini[19]
200230 mg/m2/d IV on days-4 and -3, 4 hrs after cyclophosphamide administration 30 mg/kg days on -4 and-3 Thiotepa 15 or 10 mg/kg (38 patients); thiotepa 5 mg/kg (7 patients) Conditioning regimen was generally well tolerated in terms of mucosal or organ toxicity Schlenk[34]
200225 mg/m2/d on days-7 to-3 200 mg/m2/d on days -7 to-3 Ida 12 mg/m2/d on days-7 to-5; etoposide 250 mg/m2/d on days-4 to-3 1/11 patients developed grade IV mucositis; 3/11 developed fever >38.5°C Nagler[21]
200130 mg/m2/d IV for 6 days from day 10 to 5 4 mg/kg/d orally for 2 days on days 6 and 5 10 mg/kg/d IV for 4 days from day 4 to 1 Low median age of the patients (17.5 yrs) might have contributed to low toxicity Pawson[18]
2001Liposomal daunorubicin 80 mg/m2/d on days 1-3 Dose for the FLAG regimen not reported; 10 patients received FLAG-Ida, 2 FLAG, and 2 FLAG + liposomal daunorubicin 80 mg/m2/d on days 1-3 Badros[10]
200230 mg/m2/d IV on days-2 and-1 2.5 Gy in 2 fractions on day-2 100 mg/m2 IV over 20 min on day 1 Flu and TBI were used only in MUD cases