[Donor cell leukemia (DCL): A prospective study of its identification and treatment]. / Leucemia en células del donador (LCD): un estudio prospectivo de su identificación y tratamiento.

Donor-derived malignancies after allogeneic hematopoietic stem cell transplantation and after solid organ transplantation are considered as rare diseases. We have prospectively searched for donor cell leukemia in a 12-year period, in a single institution, in a group of 106 consecutive patients allografted because of leukemia. We have identified seven cases of donor cell leukemia; six were allografted because of relapsed acute lymphoblastic leukemia and one because of paroxysmal nocturnal hemoglobinuria/aplastic anemia. These figures suggest that the real incidence of donor cell leukemia has been underestimated. The six patients with lymphoblastic donor cell leukemia were treated prospectively with a pediatric-inspired combined chemotherapy schedule designed for de novo acute leukemia. A complete response was obtained in three out of six patients with lymphoblastic donor cell leukemia. It is possible to obtain favorable responses in donor cell leukemia patients employing combined chemotherapy. The long-term donor cell leukemia survivors remain as full chimeras and have not needed a second transplant.

Oral versus intravenous fludarabine as part of a reduced-intensity conditioning for allogeneic stem cell transplantation.

BACKGROUND: In 2003, oral fludarabine was introduced in the USA for the treatment of patients with hematologic malignancies as an alternative to its intravenous (i.v.) formulation; in 2008, it was introduced in México while the i.v. formulation was withdrawn. Accordingly, i.v. fludarabine had to be replaced by oral fludarabine as part of the conditioning regimen employed to conduct allogeneic stem cell transplantation in México. METHODS: Nonrandomized retrospective analysis of 55 patients conditioned with oral fludarabine compared with 113 patients conditioned with the i.v. formulation. In addition to fludarabine, the conditioning regimen included oral busulfan and i.v. cyclophosphamide. Donors were HLA-matched siblings. RESULTS: The clinical features of the two groups were comparable. There were no statistical differences in time to neutrophil engraftment, time to platelet engraftment, acute graft versus host disease rate and nonrelapse mortality at day 100. The overall survival of patients allografted with oral fludarabine was better than those allografted with i.v. fludarabine: 62 and 33% at 67 months, respectively (p = 0.0006). DISCUSSION: Oral fludarabine can replace its i.v. formulation as part of reduced-intensity conditioning regimens with no deleterious effect on any of the early transplantation outcomes.