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Blood, 15 December 2001, Vol. 98, No. 13, pp. 3595-3599
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Nonablative allogeneic hematopoietic transplantation as adoptive
immunotherapy for indolent lymphoma: low incidence of toxicity, acute
graft-versus-host disease, and treatment-related mortality
Issa F. Khouri,
Rima M. Saliba,
Sergio A. Giralt,
Ming-Sheng Lee,
Grace-Julia Okoroji,
Fredrick
B. Hagemeister,
Martin Korbling,
Anas Younes,
Cindy Ippoliti,
James L. Gajewski,
Peter McLaughlin,
Paolo Anderlini,
Michele L. Donato,
Fernando F. Cabanillas, and
Richard E. Champlin
From the Departments of Blood and Marrow
Transplantation, Lymphoma, Laboratory Medicine, and Pharmacy,
University of Texas M. D. Anderson Cancer Center, Houston, Texas.
This study investigated the use of a nonablative conditioning
regimen to decrease toxicity and achieve engraftment of an allogeneic blood stem cell transplant, allowing a graft-versus-malignancy effect
to occur. All patients had follicular or small cell lymphocytic lymphoma after relapse from a prior response to conventional
chemotherapy. Patients received a preparative regimen of fludarabine
(25 mg/m2 given daily for 5 days or 30 mg/m2
daily for 3 days) and intravenous cyclophosphamide (1 g/m2
given daily for 2 days or 750 mg/m2 daily for 3 days). Nine
patients received rituximab in addition to the chemotherapy. Tacrolimus
and methotrexate were used for graft-versus-host disease (GVHD)
prophylaxis. Twenty patients were studied; their median age was 51 years. Twelve were in complete remission (CR) at transplantation. All
patients achieved engraftment of donor cells. The median number of days
with severe neutropenia was 6. Only 2 patients required more than one
platelet transfusion. The cumulative incidence of acute grade II to IV
GVHD was 20%. Only one patient developed acute GVHD of greater than
grade II. All patients achieved CR. None have had a relapse of disease, with a median follow-up period of 21 months. The actuarial probability of being alive and in remission at 2 years was 84% (95% confidence interval, 57%-94%). Nonablative chemotherapy with
fludarabine/cyclophosphamide followed by allogeneic stem cell
transplantation is a promising therapy for indolent lymphoma with
minimal toxicity and myelosuppression. Further studies are warranted to
compare nonablative allogeneic hematopoietic transplantation with
alternative treatment strategies.
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