Allogeneic Stem Cell Transplantation after Reduced-Intensity Conditioning for Lymphoproliferative Disease (UHKT 1999–2005)
Authors:
V. Válková; K. Benešová; A. Vítek; J. Schwarz; M. Marková; D. Pohlreich; Z. Siegelová; P. Cetkovský
Authors‘ workplace:
Ústav hematologie a krevní transfuze, Praha
Published in:
Transfuze Hematol. dnes,13, 2007, No. 2, p. 67-72.
Category:
Comprehensive Reports, Original Papers, Case Reports
Overview
Many patients (pts) with lymphoid malignancies can be cured by (immuno)-chemotherapy including high dose therapy with autologous stem cell transplantation (ASCT). If these approaches are failing and the patients are eligible, the allogeneic stem cell transplantation (alloSCT) with graft versus leukemia/lymphoma (GVL) effect can be considered as the next step. Reduction of toxicity associated with the procedure can be achieved by reduced intensity conditioning (RIC). Here we report our experience with this approach.
Patients and Methods:
Twenty pts with median age 52 years and diagnosis of lymphoma (FCL n = 3; MCL n = 1, ALCL n = 1, HL n = 4, CLL/SLL n = 11) were transplanted between June 1999 and May 2005. Median of previous chemotherapy lines was 3 (range, 1–6) and 6 pts had previously received ASCT. Eight pts were in remission (CR or PR) and ten had resistant or progressive disease at transplantation. RIC regimens were based on fludarabine in 18 cases (14x Flu/Bu/ATG, 4x Flu-Mel, 1x FLU/CFA, 1x Flu/TBI). Nine patients were transplanted from HLA identical sibling, 3 patients from MUD and 8 were transplanted from unrelated donor with 1–2 alelic mismatches. Results: With a median follow-up of 29 months (range, 4–55 months) of living patients, the actuarial overall survival (OS) rates at 3 years were 60 %. Seven patients developed acute GVHD grade 1–2, one patient developed chronic GVHD after donor lymphocyte infusion (DLI) used for treatment of relapse, no aGVHD gr 3–4 was observed. The 100-day and 1-year transplant-related mortality (TRM) rates were 25 % and 30 %. The major cause of death was infection during neutropenia (5 out of 7 deaths). DLI was used in one patient for relapse and CR was achieved. Four out of ten patients transplanted in resistant or progressive disease achieved remission (CR or uCR) and are still alive.
Conclusion:
RIC alloSCT is a feasible approach for the treatment of patients with lymphoproliferative disease with GVL effect demonstrated in chemo-resistant subgroup of pts. The TRM in this heterogenic group was however higher than expected, but it was not linked directly to GVHD and was associated with chemo-resistant disease and previous ASCT. The proper patients selection, the early identification of those who are unlikely to profit from immuno-chemotherapy only and earlier use of alloSCT with GVL effect needs to be explored.
Key words:
non-Hodgkin’s lymphoma, allogeneic, hematopoietic stem cell transplantation, GVHD
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Haematology Internal medicine Clinical oncologyArticle was published in
Transfusion and Haematology Today
2007 Issue 2
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