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Nonablative Allogeneic Stem-Cell Transplantation for Advanced/Recurrent Mantle-Cell Lymphoma

Issa F. Khouri, Ming-S. Lee, Rima M. Saliba, Gu Jun, Luis Fayad, Anas Younes, Barbara Pro, Sandra Acholonu, Peter McLaughlin, Ruth L. Katz, Richard E. Champlin

From the Departments of Blood and Marrow Transplantation, Laboratory Medicine, Lymphoma, and Pathology, the University of Texas M.D. Anderson Cancer Center, Houston, TX.

Address reprint requests to Issa F. Khouri, MD, Department of Blood and Marrow Transplantation, Unit 423, the University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030; e-mail: ikhouri{at}mdanderson.org.

Purpose: Patients with relapsed mantle-cell lymphoma have poor prognosis and short survival. Our aim was to determine the efficacy of nonablative allogeneic stem-cell transplantation in patients with relapsed mantle-cell lymphoma.

Patients and Methods: Eighteen patients were treated in one of two consecutive trials. Thirteen patients underwent a conditioning regimen of fludarabine (30 mg/m² daily for 3 days), cyclophosphamide (750 mg/m² daily for 3 days), and high-dose rituximab. For the remaining five patients, the conditioning regimen consisted of cisplatin (25 mg/m² daily for 4 days), fludarabine (30 mg/m² daily for 2 days), and cytarabine (1,000 mg/m² daily for 2 days). Tacrolimus and methotrexate were used for graft-versus-host disease prophylaxis.

Results: The median age was 56.5 years. Patients underwent a median of three prior chemotherapy regimens. Prior autologous transplantation failed in five (28%) patients and 16 (89%) had chemosensitive disease. Donor cell engraftment occurred in all patients. Eight patients (44%) required no platelet or RBC transfusion, and acute graft-versus-host disease of greater than grade 2 did not develop in any patient. The day-100 mortality was 0%. Complete remission (CR) occurred in 17 patients. Three patients progressed, and one was reinduced into continuous CR with donor lymphocyte infusion. With a median follow-up period of 26 months, the actuarial probability of current-event-free-survival at 3 years was 82% (95% CI, 65% to 99%).

Conclusion:Our data suggest that nonablative allogeneic transplantation is a safe and potentially effective strategy for patients with relapsed and chemosensitive mantle-cell lymphoma.

This study was supported in part by research grants from the G & P Foundation for Cancer Research.

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