Allogeneic bone marrow transplantation for low-grade lymphoma and chronic lymphocytic leukemia.
Twenty-six patients with low-grade lymphoma (LGL) (n = 18) or chronic lymphocytic leukemia (CLL) (n = 8) received allogeneic BMTs between 1985 and 1998. Median age was 42 years, median interval from diagnosis to transplant 22 months and median number of prior treatments three. Twenty (77%) had stage IV disease; 22 (85%) had never achieved CR. Donor source was HLA matched sibling (n = 19, 73%), matched unrelated (n = 6, 23%) or syngeneic (n = 1). Conditioning therapy included total body irradiation in 23 patients and busulphan in three. Twenty-five received GVHD prophylaxis with cyclosporine A; + methotrexate (n = 19), + methylprednisolone (n = 2) or + T cell depletion of allograft +/- methotrexate (n = 4). Sixteen patients are alive, a median of 2.4 years post BMT. Death occurred due to transplant complications (n = 7) or underlying disease (n = 3). Eighteen (12 LGL, six CLL) of 22 evaluable patients (82%) achieved CR post BMT. Cumulative incidence of refractory/recurrent disease was 18% (95% confidence interval (CI) 7-42%). Overall and event-free survivals were 58% (95% CI 35-75%) and 54% (95% CI 32-72%), respectively. Allogeneic BMT for young patients with advanced LGL or CLL is feasible and can result in long-term disease-free survival.
Toze
C L
CL
Leukemia/Bone Marrow Transplantation Program of British Columbia: Division of Hematology, British Columbia Cancer Agency, Vancouver Hospital and Health Sciences Centre and University of British Columbia, Vancouver, British Columbia, Canada.
Shepherd
J D
JD
Connors
J M
JM
Voss
N J
NJ
Gascoyne
R D
RD
Hogge
D E
DE
Klingemann
H G
HG
Nantel
S H
SH
Nevill
T J
TJ
Phillips
G L
GL
Reece
D E
DE
Sutherland
H J
HJ
Barnett
M J
MJ
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use / Q000633:toxicity; D016026:Bone Marrow Transplantation / Q000401:mortality; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000633:toxicity; D018572:Disease-Free Survival; D005047:Etoposide / Q000008:administration & dosage / Q000633:toxicity; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000453:epidemiology; D006470:Hemorrhage; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000150:complications / Q000401:mortality / Q000628:therapy*; D017708:Leukocyte Transfusion / Q000401:mortality; D008168:Lung / Q000473:pathology; D008228:Lymphoma, Non-Hodgkin / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017713:Platelet Transfusion / Q000401:mortality; D012008:Recurrence; D015996:Survival Rate; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous / Q000401:mortality; D016896:Treatment Outcome; D014916:Whole-Body Irradiation
D005047:Etoposide; D003520:Cyclophosphamide