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Randomized Controlled Trial
. 2007 Oct;13(10):1185-91.
doi: 10.1016/j.bbmt.2007.06.011. Epub 2007 Aug 3.

Induction of autologous graft-versus-host disease: results of a randomized prospective clinical trial in patients with poor risk lymphoma

Javier Bolaños-Meade  1 , Elizabeth Garrett-Mayer, Leo Luznik, Viki Anders, Jennifer Webb, Ephraim J Fuchs, Carol Ann Huff, William Matsui, Ivan M Borrello, Robert Brodsky, Yvette L Kasamon, Lode J Swinnen, Ian W Flinn, Richard F Ambinder, Richard J Jones, Allan D Hess, Georgia B Vogelsang
Affiliations
Randomized Controlled Trial

Induction of autologous graft-versus-host disease: results of a randomized prospective clinical trial in patients with poor risk lymphoma

Javier Bolaños-Meade et al. Biol Blood Marrow Transplant. 2007 Oct.

Abstract

The results of blood or marrow transplantation in patients with chemorefractory aggressive lymphoma, that is, those not responding to conventional-dose chemotherapy at the time of transplant, have been poor. The relapse rate has been high after autologous bone marrow transplant, whereas allogeneic transplantation has been associated with excessive transplant-related toxicity. Administration of cyclosporine after autologous transplantation can induce an autoreactive syndrome that resembles graft-versus-host disease (GVHD). This syndrome, named autologous graft-versus-host disease, has clear antitumor activity in animal models that can be enhanced by the addition of cytokines such as gamma-interferon and interleukin-2. A randomized, prospective study was conducted to evaluate the antitumor effect of autologous graft-versus-host disease induced with cyclosporine, and augmented by the administration of gamma-interferon and interleukin-2 in patients with chemorefractory Hodgkin and aggressive non-Hodgkin lymphomas. Fifty-one patients were randomized, 24 to the autologous GVHD induction arm, and 27 to the noninduction arm after autologous transplant using mobilized peripheral blood stem cell (PBSC) grafts. There were no differences in treatment-related mortality, overall and event-free survival (OS, EFS) between both groups; however, in the induction arm, GVHD developed only in 4 patients. The administration of oral cyclosporine followed by interleukin-2 and gamma-interferon is generally not well tolerated, and does not appear to be an effective method to induce autologous GVHD in patients receiving autologous PBSC grafts.

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Figures

Figure 1
Figure 1
Competing risks analysis of relapse and death, based on intention to treat analysis. (n=24 patients randomized to the treatment group, n=27 patients randomized to control group).
Figure 2
Figure 2
Competing risks analysis of relapse and death, based on “per protocol” analysis (n=18 patients in the treatment group, n=25 patients in the control group).
Figure 3
Figure 3
A) Overall survival (intention to treat analysis) and B) event-free (relapse or death) survival (intention to treat analysis).
See this image and copyright information in PMC

References

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