Allografting after nonmyeloablative conditioning as a treatment after a failed conventional hematopoietic cell transplant

Outcomes with conventional allogeneic hematopoietic cell transplantation (HCT) after failed HCT are typically poor. To reduce transplantation-related mortality (TRM), 55 patients (median age, 43 years; range, 18-69 years) who had failed conventional autologous (n = 49), allogeneic (n = 4), or syngeneic (n = 2) HCT received human leukocyte antigen-matched related (n 31) or unrelated (n = 24) donor allografts after nomnyeloablative conditioning with 2 Gy of total body irradiation or 2 Gy of total body irradiation and 90 mg/m(2) of fludarabine. Postgrafting inununosuppression consisted of cyclosporine and mycophenolate mofetil. One rejection occurred. Thirty-three patients died a median of 127 days (range, 7-834 days) after HCT: 21 of relapse, 11 of TRM, and 1 of suicide. The TRM rate on day 100 was 11 % with an estimated 1-year TRM rate of 20% (95% confidence interval [CI], 9% to 3 1 %). The median follow-up among the 22 survivors is 368 days (range, 173-796 days). Seventeen of 22 survivors are progression-free. One-year estimates of overall and progression-free survival rates are 49% (95% CI, 35% to 62%) and 28% (95% CI, 16% to 41%), respectively. Untreated disease at the time of allografting after nomnyeloablative conditioning increased the risk of death (hazard ratio = 2.4; P = .04). Although the length of follow-up is still short, it appears that encouraging outcomes can be achieved with nomnyeloablative conditioning in patients expected to have poor outcomes with conventional allografting. (C) 2003 American Society for Blood and Marrow Transplantation.