Allogeneic peripheral blood stem cell transplantation for high-risk non-Hodgkin's lymphoma

Bone Marrow Transplant. 2003 Oct;32(8):763-9. doi: 10.1038/sj.bmt.1704233.

Abstract

A high incidence of nonrelapse mortality (NRM) has limited the use of allogeneic transplantation for poor prognosis non-Hodgkin's lymphoma (NHL). We sought to improve the outcome of allografting by utilizing Filgrastim-mobilized peripheral blood stem cells (PBSC) in combination with either standard ablative or reduced-intensity conditioning. A total of 21 patients with intermediate/high-grade lymphoma and seven patients with low-grade histology were enrolled on protocols using PBSC. All patients were considered high risk for recurrence and/or NRM because of age >50 (n=16), refractory disease (n=17), failed autologous transplant (n=11) and abnormal organ function (n=2). In all, 17 patients received ablative regimens and 11 received modified conditioning including fludarabine, intravenous busulfan and ATG. Tacrolimus and mini-dose methotrexate were used for graft-versus-host-disease (GVHD) prophylaxis. Median follow-up was 38 months. Disease-free and overall survival were 57 and 58%. Seven of the 11 patients who relapsed after a previous transplant remain disease free. Four of the 10 patients with recurrent/persistent disease post transplant responded to additional therapy including withdrawal of immunosuppression+/-DLI. These results support a potent graft-versus-lymphoma effect and suggest that patients who relapse after an autologous transplant can be salvaged with an allogeneic transplant.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Disease-Free Survival
  • Drug Therapy, Combination
  • Female
  • Follow-Up Studies
  • Graft vs Host Disease / diagnosis
  • Graft vs Host Disease / drug therapy
  • Hematopoietic Stem Cell Transplantation / adverse effects
  • Hematopoietic Stem Cell Transplantation / mortality*
  • Humans
  • Immunosuppressive Agents / administration & dosage
  • Lymphoma, Non-Hodgkin / mortality*
  • Lymphoma, Non-Hodgkin / therapy*
  • Male
  • Methotrexate / administration & dosage
  • Middle Aged
  • Recurrence
  • Risk Factors
  • Survival Rate
  • Tacrolimus / administration & dosage
  • Transplantation, Homologous

Substances

  • Immunosuppressive Agents
  • Tacrolimus
  • Methotrexate