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Clinical Trial
. 2008 Jun 15;111(12):5530-6.
doi: 10.1182/blood-2008-01-136242. Epub 2008 Apr 14.

Eight-year experience with allogeneic stem cell transplantation for relapsed follicular lymphoma after nonmyeloablative conditioning with fludarabine, cyclophosphamide, and rituximab

Issa F Khouri  1 , Peter McLaughlin, Rima M Saliba, Chitra Hosing, Martin Korbling, Ming S Lee, L Jeffrey Medeiros, Luis Fayad, Felipe Samaniego, Amin Alousi, Paolo Anderlini, Daniel Couriel, Marcos de Lima, Sergio Giralt, Sattva S Neelapu, Naoto T Ueno, Barry I Samuels, Fredrick Hagemeister, Larry W Kwak, Richard E Champlin
Affiliations
Clinical Trial

Eight-year experience with allogeneic stem cell transplantation for relapsed follicular lymphoma after nonmyeloablative conditioning with fludarabine, cyclophosphamide, and rituximab

Issa F Khouri et al. Blood. .

Erratum in

  • Blood. 2009 Feb 12;113(7):1613

Abstract

Nonmyeloablative stem cell transplantation in patients with follicular lymphoma has been designed to exploit the graft-versus-lymphoma immunity. The long-term effectiveness and toxicity of this strategy, however, is unknown. In this prospective study, we analyzed our 8-year experience. Patients received a conditioning regimen of fludarabine (30 mg/m(2) daily for 3 days), cyclophosphamide (750 mg/m(2) daily for 3 days), and rituximab (375 mg/m(2) for 1 day plus 1000 mg/m(2) for 3 days). They were then given an infusion of human leukocyte antigen-matched hematopoietic cells from related (n = 45) or unrelated donors (n = 2). Tacrolimus and methotrexate were used for graft-versus-host disease (GVHD) prophylaxis. Forty-seven patients were included. All patients experienced complete remission, with only 2 relapses. With a median follow-up time of 60 months (range, 19-94), the estimated survival and progression-free survival rates were 85% and 83%, respectively. All 18 patients who were tested and had evidence of JH/bcl-2 fusion transcripts in the bone marrow at study entry experienced continuous molecular remission. The incidence of grade 2-IV acute GVHD was 11%. Only 5 patients were still undergoing immunosuppressive therapy at the time of last follow-up. We believe that the described results are a step forward toward developing a curative strategy for recurrent follicular lymphoma.

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Figures

Figure 1
Figure 1
Peripheral blood CD19+ recovery after transplantation.
Figure 2
Figure 2
Proportion of patients with normal immunoglobulin (Ig) levels after transplantation.
Figure 3
Figure 3
OS (solid line) and PFS were 85% and 83%, respectively, with a median follow-up of 60 months (range, 19-94 months).
Figure 4
Figure 4
Incidence of severe acute GVHD after nonmyeloablative stem cell transplantation.
Figure 5
Figure 5
Incidence (—) and survival duration (----) of patients with chronic extensive and limited GVHD.
See this image and copyright information in PMC

Comment in

References

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    1. Shipp MA, Harrington DP, Anderson JR, et al. The International Non- Hodgkin's Lymphoma Prognostic Factors Project: a predictive model for aggressive non-Hodgkin's lymphoma. N Engl J Med. 1993;329:987–994. - PubMed

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