The incidence of acute and chronic GvHD was comparable with that reported in younger patients. On median day +170, 9 patients relapsed (2-year cumulative relapse risk, 27.3% [95% CI, 15%- 49.7%]). Of 7 relapsed patients, 3 responded to donor lymphocyte infusions (DLIs) and 2 patients overall were successfully salvaged (1 with DLI, 1 with second HCT). After a median follow-up of 913 days (range, 55-1591 days), 22 patients (65%) are alive with all but 1 in complete remission (CR). Most of the survivors report feeling well (median Karnofsky performance score [KPS], 100%; 70-100), with only 2 patients requiring chronic immunosuppression. The actuarial 2-year overall survival (OS) and event-free survival (EFS) probability were 62.7% (95% CI, 44.9%-80.4%) and 53.1% (95% CI, 34.8%-71.4%), respectively (Figure 1). Interestingly, higher numbers of CD34 + cells in the PB graft were associated with improved outcome (P = .044). This correlation could not be explained by a higher incidence of chronic GvHD with increasing numbers of CD34 + PB cells, as suggested by others. 7 Since age affects CD34 + cell yield during apheresis, it seems reasonable to consider lower age as a selection criterion when choosing a donor. Allogeneic PB-HCT from unrelated donors using the FBM/ ATG protocol is an effective treatment for patients 60 years or older with high-risk myeloid malignancies. The sustained remissions observed in 7 of 11 previously untreated sAML (AML secondary to MDS) or MDS patients suggest that at least for candidates with a slow increase of blasts over time, transplantation may be used as a front-line therapy. Alexandros Spyridonidis, Hartmut Bertz, Gabriele Ihorst, Carsten Gru ¨ llich, and Ju ¨ rgen Finke Correspondence: Ju ¨rgen Finke, Freiburg University Medical Center, Hugstetterstrasse 55, 79106 Freiburg, Germany; e-mail: finke@mm11.ukl.uni- freiburg.de References 1. Bertz H, Potthoff K, Finke J. Allogeneic stem-cell transplantation from related and unrelated donors in older patients with myeloid leukemia. J Clin Oncol. 2003;21:1480-1484. 2. Wong R, Giralt SA, Martin T, et al. Reduced-intensity conditioning for unrelated donor hematopoietic stem cell transplantation as treatment for myeloid malig- nancies in patients older than 55 years. Blood. 2003;102:3052-3059. 3. Maris MB, Niederwieser D, Sandmaier BM, et al. HLA-matched unrelated do- nor hematopoietic cell transplantation after nonmyeloablative conditioning for patients with hematologic malignancies. Blood. 2003;102:2021-2030. 4. Ho AY, Pagliuca A, Kenyon M, et al. Reduced-intensity allogeneic haematopoi- etic stem cell transplantation for myelodysplastic syndrome and acute myeloid leukaemia with multilineage dysplasia using fludarabine, busulphan, and alem- tuzumab (FBC) conditioning. Blood. 2004;104:1616-1623. 5. Chakraverty R, Peggs K, Chopra R, et al. Limiting transplantation-related mor- tality following unrelated donor stem cell transplantation by using a nonmyelo- ablative conditioning regimen. Blood. 2002;99:1071-1078. 6. de Lima M, Couriel D, Thall PF, et al. Once-daily intravenous busulfan and flu- darabine: clinical and pharmacokinetic results of a myeloablative, reduced-tox- icity conditioning regimen for allogeneic stem cell transplantation in AML and MDS. Blood. 2004;104:857-864. 7. Perez-Simon JA, Diez-Campelo M, Martino R, et al. Impact of CD34+ cell dose on the outcome of patients undergoing reduced-intensity-conditioning alloge- neic peripheral blood stem cell transplantation. Blood. 2003;102:1108-1113. To the editor: No cardiac toxicity associated with alemtuzumab therapy for mycosis fungoides/Se ´zary syndrome We read with interest the article from Lenihan et al. 1 In this report, 4 of 8 patients with mycosis fungoides/Se ´zary syndrome (MF/SS) were reported to have developed either congestive heart failure or cardiac arrhythmia during alemtuzumab (Mab- Campath, Campath; Schering, Berlin, Germany) treatment. None had a history of cardiac problems, and cardiotoxicity during therapy was considerably improved after discontinua- tion, suggesting a link with alemtuzumab. They suggest that the cardiotoxicity might be explained by cytokine release or direct effects on the heart. We therefore rechecked the individual files of 30 patients with advanced MF/SS who had participated in European trials of alemtuzumab. A complete physical examination and electrocar- diogram (ECG) were performed at baseline. Physical re-examination was performed regularly during and after treat- ment. ECG was repeated if there were clinical signs of cardiac disease. Based on these analyses, we cannot confirm the find- ings of Lenihan’s study. 1 In a phase 2 trial of 22 patients with MF/SS, 2 there was no clinical cardiac toxicity during or after alemtuzumab treatment. Similar to the study by Lenihan, 1 alemtuzumab was administered intravenously on 3 consecutive days at doses (3 mg, 10 mg, and 30 mg), followed by 30 mg 3 times weekly for up to 12 weeks. The overall response rate was 55%; 32% complete remissions and 23% partial remissions. Median cumulative alemtuzumab dose was 913 mg (range 253 mg-1063 mg) compared with 30 mg to 553 mg in Lenihan’s study. There were 7 of 22 patients who were considered to have pre-existing cardiac risk (previous myocardial infarction, n = 1; hypertension, n = 4; cardiomyopathy, n = 1; angina pectoris, n = 1; congestive heart failure/mitral insufficiency, n = 1). There were 5 patients who had received prior doxoru- bicin; the median cumulative dose was 408 mg (range, 255 Figure 1. 4148 CORRESPONDENCE BLOOD, 15 MAY 2005  VOLUME 105, NUMBER 10 Downloaded from http://ashpublications.org/blood/article-pdf/105/10/4148/1708972/zh801005004146c.pdf by guest on 31 July 2022