![]() ![]() ![]() The most significant contributor to NRM was GvHD.īetween 19 a number of changes in clinical practice were introduced that were aimed at improving HCT outcomes including reductions in the use of systemic glucocorticoids as treatment for acute GvHD, 2, 3 use of ursodiol to reduce hepatic complications, 4, 5 addition of sirolimus for control of GvHD, 6-8 use of fluoroquinolones for antibacterial prophylaxis during periods of neutropenia, 9-11 use of more mold-active azoles for antifungal prophylaxis, 12, 13 and initiation of pre-emptive antiviral therapy based on more sensitive polymerase chain reaction (PCR)- based cytomegalovirus (CMV) diagnostic testing. 1 Five-year overall survival ranged from 25% to 60% (depending on disease type, comorbidities, and graft- versus- host disease ), non-relapse mortality (NRM) was 24%, and relapse-related mortality was 35%. We previously reported outcomes for patients who underwent HCT from 1997–2009 using this regimen, which included lowdose total body irradiation (TBI) with or without fludarabine. In 1997 we introduced a minimally intensive conditioning regimen for allogeneic hematopoietic cell transplantation (HCT) that enabled treating elderly and medically infirm younger patients with advanced hematologic malignancies in the outpatient setting. For patients with hematologic malignancies who underwent transplantation with non-myeloablative conditioning, outcomes have improved during the past two decades. The proportion of patients ≥60 years old increased from 27% in 1997 +/- 2003 to 56% in 2010–2017, and with scores from the Hematopoietic Cell Transplantation Comborbidity Index of ≥3 increased from 25% in 1997 +/- 2003 to 45% in 2010 +/- 2017. From 1997-2017, 1,720 patients with hematologic malignancies received low-dose total body irradiation +/- fludarabine or clofarabine before transplantation from HLA-matched sibling or unrelated donors, followed by mycophenolate mofetil and a calcineurin inhibitor ± sirolimus. We hypothesized that improvements in clinical practice led to better transplantation outcomes over time. ![]() During that period, changes in clinical practice have been aimed at reducing morbidity and mortality from infections, organ toxicity, and graft-versus-host disease. We have used a non-myeloablative conditioning regimen for allogeneic hematopoietic cell transplantation for the past twenty years. ![]()
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