Second autologous transplant with cyclosporin/interferon alpha-induced graft versus host disease for patients who have failed first-line consolidation.
The prognosis for patients with non-Hodgkin's lymphoma (NHL) and advanced Hodgkin's disease (HD) who relapse following autologous transplant is poor. We report on a pilot study designed to evaluate the feasibility of using Cyclosporin A and interferon alpha to induce autologous GVHD following a second autologous transplant for relapsed lymphoma. In all, 10 patients entered the study with median age 46.5 years. Diagnosis was NHL (n=7) or Hodgkin's lymphoma (n=3). All had relapsed from a prior autologous transplant. The second transplant was well tolerated by all patients. Histological changes consistent with cutaneous GVHD developed in 30% of patients at a median of 22.5 days from transplant and settled spontaneously in all cases. Five patients have died (four from progressive disease) at a median 7 months from second transplant. Five patients are still alive and in complete remission at a median of 20 months from transplant. Median overall survival for the group is 13.5 months and median relapse-free survival has not been reached at 42 months. This is a well-tolerated regimen for use in this poor-risk group of patients with lymphoma. The overall survival and event-free survival are encouraging, however further studies are necessary.
Streetly
M
M
Department of Haematology, Guys Hospital, Guys and St Thomas' NHS Trust, London, UK.
Kazmi
M
M
Radia
D
D
Hoyle
C
C
Schey
S A
SA
D000328:Adult; D016572:Cyclosporine / Q000008:administration & dosage / Q000494:pharmacology*; D005260:Female; D006086:Graft vs Host Disease / Q000139:chemically induced*; D006087:Graft vs Host Reaction; D006689:Hodgkin Disease / Q000401:mortality / Q000628:therapy; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage / Q000494:pharmacology; D016898:Interferon-alpha / Q000008:administration & dosage / Q000494:pharmacology*; D008223:Lymphoma / Q000401:mortality / Q000628:therapy*; D008228:Lymphoma, Non-Hodgkin / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation / Q000379:methods*; D010865:Pilot Projects; D016879:Salvage Therapy / Q000379:methods*; D016019:Survival Analysis; D014182:Transplantation, Autologous; D016896:Treatment Outcome
D007155:Immunologic Factors; D016898:Interferon-alpha; D016572:Cyclosporine