Reduced-intensity allogeneic transplantation for lymphoma.
Reduced-intensity allogeneic transplants are promising, increasingly used treatments for hematologic malignancies, exploiting graft-versus-tumor effects for eradicating malignancies. This article reviews approximately 40 published reports of reduced-intensity allogeneic transplants in lymphomas. Overall, reduced-intensity allogeneic transplants have been well tolerated and have produced encouraging results despite a diversity of transplant approaches used largely in heavily pretreated and older patients. Of 368 lymphoma patients who underwent reduced-intensity allogeneic transplants, 66.3% had responses, most of which were complete. Many had chemotherapy-refractory lymphomas, including some that relapsed after autologous transplants. Although the short follow-up periods of many studies do not permit assessments of response duration, protracted remissions were reported in some studies. Additionally, some patients entered molecular remissions, suggesting that graft-versus-tumor effects could, by themselves, cure some lymphomas. Graft-versus-host disease is the major risk of reduced-intensity allogeneic transplants, and treatment methods need refinement to reduce transplant risks while preserving graft-versus-tumor effects. Controlled trials involving patients with earlier-stage disease appear warranted to define better the role of reduced-intensity allogeneic transplants in treating lymphomas.
Kogel
Karen E
KE
University of Colorado Health Sciences Center, Denver 80262, USA.
McSweeney
Peter A
PA
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D006086:Graft vs Host Disease; D020350:Graft vs Tumor Effect; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008223:Lymphoma / Q000628:therapy*; D036102:Peripheral Blood Stem Cell Transplantation; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D007166:Immunosuppressive Agents