Originally published as JCO Early Release 10.1200/JCO.2007.11.5477 on December 3 2007

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Nonmyeloablative Allogeneic Hematopoietic Cell Transplantation in Relapsed, Refractory, and Transformed Indolent Non-Hodgkin's Lymphoma

Andrew R. Rezvani, Barry Storer, Michael Maris, Mohamed L. Sorror, Edward Agura, Richard T. Maziarz, James C. Wade, Thomas Chauncey, Stephen J. Forman, Thoralf Lange, Judith Shizuru, Amelia Langston, Michael A. Pulsipher, Brenda M. Sandmaier, Rainer Storb, David G. Maloney

From the Fred Hutchinson Cancer Research Center; University of Washington; Veterans Affairs Puget Sound Health System, Seattle, WA; Rocky Mountain Cancer Center, Denver, CO; Baylor University, Dallas, TX; Oregon Health and Science University, Portland, OR; Medical College of Wisconsin, Milwaukee, WI; City of Hope National Medical Center, Duarte; Stanford University, Stanford, CA; Emory University, Atlanta, GA; University of Utah, Salt Lake City, UT; and University of Leipzig, Leipzig, Germany

Corresponding author: David G. Maloney, MD, PhD, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, MS D1-100, Seattle, WA 98109; e-mail: dmaloney{at}fhcrc.org

Purpose Few effective treatment options exist for chemotherapy-refractory indolent or transformed non-Hodgkin's lymphoma (NHL). We examined the outcome of nonmyeloablative allogeneic hematopoietic cell transplantation (HCT) in this setting.

Patients and Methods Sixty-two patients with indolent or transformed NHL were treated with allogeneic HCT from related (n = 34) or unrelated (n = 28) donors after conditioning with 2 Gy of total-body irradiation with or without fludarabine. Nine unrelated donors were mismatched for one HLA antigen. Sixteen patients had histologic transformation before HCT. Twenty patients (32%) had progressive disease after previous high-dose therapy with autologous HCT. Median age was 54 years, and patients had received a median of six lines of treatment before HCT. Median follow-up time after HCT was 36.6 months.

Results At 3 years, the estimated overall survival (OS) and progression-free survival (PFS) rates were 52% and 43%, respectively, for patients with indolent disease, and 18% and 21%, respectively, for patients with transformed disease. Patients with indolent disease and related donors (n = 26) had 3-year estimated OS and PFS rates of 67% and 54%, respectively. The incidences of grade 2 to 4 acute graft-versus-host disease (GVHD), grade 3 and 4 acute GVHD, and extensive chronic GVHD were 63%, 18%, and 47%, respectively. Among survivors, the median Karnofsky performance status at last follow-up was 85%.

Conclusion Nonmyeloablative allogeneic HCT can produce durable disease-free survival in patients with relapsed or refractory indolent NHL, even in this relatively elderly and heavily pretreated cohort. Outcomes were particularly good in patients with untransformed disease and related donors, whereas patients with transformed disease did poorly. Long-term survivors reported good overall functional status.

published online ahead of print at www.jco.org on December 3, 2007.

Supported by Grants No. CA78902, CA18029, CA15704, and K99-HL088021 from the National Institutes of Health, Bethesda, MD.

Presented in part as a poster at the 48th Annual Meeting of the American Society of Hematology, December 9-12, 2006, Orlando, FL.

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

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