title: Nonmyeloablative allogeneic hematopoietic transplantation: a promising salvage therapy for patients with non-Hodgkin's lymphoma whose disease has failed a prior autologous transplantation.
abstract: OBJECTIVE
  Allogeneic transplantation for patients with lymphoma who experience a recurrence after an autologous transplantation has been considered a hazardous therapeutic choice. We investigated the safety and efficacy of nonmyeloablative stem-cell transplantation in these patients.
  
  
  METHODS
  Patients were required to have chemosensitive or stable disease. Twenty consecutive patients were treated in two sequential trials. Fifteen patients underwent a preparative regimen of fludarabine (30 mg/m(2) daily for 3 days), intravenous cyclophosphamide (750 mg/m(2) daily for 3 days), and rituximab. For the remaining five patients, the conditioning regimen consisted of cisplatin (25 mg/m(2) continuous infusion daily for 4 days), fludarabine (30 mg/m(2) daily for 2 days), and cytarabine (1,000 mg/m(2) daily for 2 days). Tacrolimus and methotrexate were used for graft-versus-host disease prophylaxis.
  
  
  RESULTS
  All patients experienced engraftment of donor cells. One patient (5%) experienced grade 2 acute graft-versus-host disease, and no patients experienced a higher grade. One patient experienced disease progression at 115 days post-transplantation and responded to donor lymphocyte infusion. The remaining patients remained disease-free. One patient died at 10.5 months from a fungal infection. With a median follow-up time of 25 months, the estimated 3-year current progression-free survival rate was 95%.
  
  
  CONCLUSIONS
  These data suggest that nonmyeloablative allogeneic stem-cell transplantation is an effective option in lymphoma patients with chemosensitive or stable disease who experience disease recurrence following autologous transplantation.
authors.affiliation: Department of Blood and Marrow Transplantation, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Maricer P
authors.initials: MP
authors.lastname: Escalón
authors.forename: Richard E
authors.initials: RE
authors.lastname: Champlin
authors.forename: Rima M
authors.initials: RM
authors.lastname: Saliba
authors.forename: Sandra A
authors.initials: SA
authors.lastname: Acholonu
authors.forename: Chitra
authors.initials: C
authors.lastname: Hosing
authors.forename: Luis
authors.initials: L
authors.lastname: Fayad
authors.forename: Sergio
authors.initials: S
authors.lastname: Giralt
authors.forename: Naoto T
authors.initials: NT
authors.lastname: Ueno
authors.forename: Farzaneh
authors.initials: F
authors.lastname: Maadani
authors.forename: Barbara
authors.initials: B
authors.lastname: Pro
authors.forename: Michele
authors.initials: M
authors.lastname: Donato
authors.forename: Peter
authors.initials: P
authors.lastname: McLaughlin
authors.forename: Issa F
authors.initials: IF
authors.lastname: Khouri
mesh_terms: D000328:Adult; D006086:Graft vs Host Disease; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000628:therapy*; D008875:Middle Aged; D016879:Salvage Therapy; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous