This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Escalón, M. P. Articles by Khouri, I. F. Search for Related Content PubMed PubMed Citation Articles by Escalón, M. P. Articles by Khouri, I. F. Social Bookmarking                            What's this?

Nonmyeloablative Allogeneic Hematopoietic Transplantation: A Promising Salvage Therapy for Patients With Non-Hodgkin's Lymphoma Whose Disease Has Failed a Prior Autologous Transplantation

From the Departments of Blood and Marrow Transplantation and Lymphoma, Division of Cancer Medicine, 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, Box 423, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030; e-mail: ikhouri{at}mdanderson.org

PURPOSE: Allogeneic transplantation for patients with lymphoma who experience a recurrence after an autologous transplantation has been considered a hazardous therapeutic choice. We investigated the safety and efficacy of nonmyeloablative stem-cell transplantation in these patients.

PATIENTS AND METHODS: Patients were required to have chemosensitive or stable disease. Twenty consecutive patients were treated in two sequential trials. Fifteen patients underwent a preparative regimen of fludarabine (30 mg/m² daily for 3 days), intravenous cyclophosphamide (750 mg/m² daily for 3 days), and rituximab. For the remaining five patients, the conditioning regimen consisted of cisplatin (25 mg/m² continuous infusion 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: All patients experienced engraftment of donor cells. One patient (5%) experienced grade 2 acute graft-versus-host disease, and no patients experienced a higher grade. One patient experienced disease progression at 115 days post-transplantation and responded to donor lymphocyte infusion. The remaining patients remained disease-free. One patient died at 10.5 months from a fungal infection. With a median follow-up time of 25 months, the estimated 3-year current progression-free survival rate was 95%.

CONCLUSION: These data suggest that nonmyeloablative allogeneic stem-cell transplantation is an effective option in lymphoma patients with chemosensitive or stable disease who experience disease recurrence following autologous transplantation.

Supported in part by research grants from The G & P Foundation for Cancer Research.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				K. J. Thomson, E. C. Morris, A. Bloor, G. Cook, D. Milligan, A. Parker, F. Clark, L. Yung, D. C. Linch, R. Chakraverty, et al. Favorable Long-Term Survival After Reduced-Intensity Allogeneic Transplantation for Multiple-Relapse Aggressive Non-Hodgkin's Lymphoma J. Clin. Oncol., January 20, 2009; 27(3): 426 - 432. [Abstract] [Full Text] [PDF]

				C. A. Rodrigues, G. Sanz, C. G. Brunstein, J. Sanz, J. E. Wagner, M. Renaud, M. de Lima, M. S. Cairo, S. Furst, B. Rio, et al. Analysis of Risk Factors for Outcomes After Unrelated Cord Blood Transplantation in Adults With Lymphoid Malignancies: A Study by the Eurocord-Netcord and Lymphoma Working Party of the European Group for Blood and Marrow Transplantation J. Clin. Oncol., January 10, 2009; 27(2): 256 - 263. [Abstract] [Full Text] [PDF]

				M. R. Bishop, R. M. Dean, S. M. Steinberg, J. Odom, S. Z. Pavletic, C. Chow, S. Pittaluga, C. Sportes, N. M. Hardy, J. Gea-Banacloche, et al. Clinical evidence of a graft-versus-lymphoma effect against relapsed diffuse large B-cell lymphoma after allogeneic hematopoietic stem-cell transplantation Ann. Onc., November 1, 2008; 19(11): 1935 - 1940. [Abstract] [Full Text] [PDF]

				A. R. Rezvani, B. Storer, M. Maris, M. L. Sorror, E. Agura, R. T. Maziarz, J. C. Wade, T. Chauncey, S. J. Forman, T. Lange, et al. Nonmyeloablative Allogeneic Hematopoietic Cell Transplantation in Relapsed, Refractory, and Transformed Indolent Non-Hodgkin's Lymphoma J. Clin. Oncol., January 10, 2008; 26(2): 211 - 217. [Abstract] [Full Text] [PDF]

				N. Schmitz, P. Dreger, B. Glass, and A. Sureda Allogeneic transplantation in lymphoma: current status Haematologica, November 1, 2007; 92(11): 1533 - 1548. [Abstract] [Full Text] [PDF]

				R. M. Saliba, M. de Lima, S. Giralt, B. Andersson, I. F. Khouri, C. Hosing, S. Ghosh, J. Neumann, Y. Hsu, J. De Jesus, et al. Hyperacute GVHD: risk factors, outcomes, and clinical implications Blood, April 1, 2007; 109(7): 2751 - 2758. [Abstract] [Full Text] [PDF]

				A. Reiter Diagnosis and Treatment of Childhood Non-Hodgkin Lymphoma Hematology, January 1, 2007; 2007(1): 285 - 296. [Abstract] [Full Text] [PDF]

				M. A. Moufarij, D. Sampath, M. J. Keating, and W. Plunkett Fludarabine increases oxaliplatin cytotoxicity in normal and chronic lymphocytic leukemia lymphocytes by suppressing interstrand DNA crosslink removal Blood, December 15, 2006; 108(13): 4187 - 4193. [Abstract] [Full Text] [PDF]

				F. Baron, R. Storb, B. E. Storer, M. B. Maris, D. Niederwieser, J. A. Shizuru, T. R. Chauncey, B. Bruno, S. J. Forman, P. A. McSweeney, et al. Factors Associated With Outcomes in Allogeneic Hematopoietic Cell Transplantation With Nonmyeloablative Conditioning After Failed Myeloablative Hematopoietic Cell Transplantation J. Clin. Oncol., September 1, 2006; 24(25): 4150 - 4157. [Abstract] [Full Text] [PDF]

				I. F. Khouri Reduced-Intensity Regimens in Allogeneic Stem-Cell Transplantation for Non-Hodgkin Lymphoma and Chronic Lymphocytic Leukemia Hematology, January 1, 2006; 2006(1): 390 - 397. [Abstract] [Full Text] [PDF]

				P. Corradini, F. Zallio, J. Mariotti, L. Farina, M. Bregni, P. Valagussa, F. Ciceri, A. Bacigalupo, A. Dodero, M. Lucesole, et al. Effect of Age and Previous Autologous Transplantation on Nonrelapse Mortality and Survival in Patients Treated With Reduced-Intensity Conditioning and Allografting for Advanced Hematologic Malignancies J. Clin. Oncol., September 20, 2005; 23(27): 6690 - 6698. [Abstract] [Full Text] [PDF]

				F. Baron, M. B. Maris, B. M. Sandmaier, B. E. Storer, M. Sorror, R. Diaconescu, A. E. Woolfrey, T. R. Chauncey, M. E.D. Flowers, M. Mielcarek, et al. Graft-Versus-Tumor Effects After Allogeneic Hematopoietic Cell Transplantation With Nonmyeloablative Conditioning J. Clin. Oncol., March 20, 2005; 23(9): 1993 - 2003. [Abstract] [Full Text] [PDF]