Outcome following alemtuzumab (CAMPATH-1H)-containing reduced intensity allogeneic transplant regimen for relapsed and refractory non-Hodgkin's lymphoma (NHL).
We report the outcome following RIT for NHL in 88 patients (LG-NHL n = 41, HG-NHL n = 37, MCL n = 10). Thirty-seven had received prior autografts and 21 were in CR at transplant. Conditioning was with alemtuzumab, fludarabine and melphalan. Sixty-five patients received PBSC from HLA-identical siblings and 23 received BM from matched unrelated donors. GVHD prophylaxis was with cyclosporin A. Grade III-IV acute GVHD developed in 4 patients and chronic GVHD in 6 patients. With a median follow-up of 36 months (range 18-60), the actuarial overall survival (OS) at 3 years was 34% for HG-NHL, 60% for MCL and 73% for LG-NHL (p < or = 0.001). The 100-day and 3-year TRM for patients with LG-NHL were 2% and 11%, respectively, and were better (p = 0.01) than for patients with HG-NHL (27% and 38%, respectively). The actuarial current progression free survival (PFS) at 3 years, including those who achieved remission following DLI for progression, was 65% for LG-NHL 50% for MCL and 34% for HG-NHL (p = 0.002). Twenty-one patients received DLI for MRD, persistent disease or relapse and 15 received DLI for mixed hematopoietic chimerism. Patients with relapsed LG-NHL and CLL achieve excellent PFS with extremely low TRM and GVHD, even when matched family donors are unavailable.
Morris
Emma
E
Department of Haematology, University College London Hospitals, 98 Chenies Mews, London W1E6HX, United Kingdom. emma.morris@ic.ac.uk
Mackinnon
Stephen
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000074323:Alemtuzumab; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm / Q000627:therapeutic use*; D018572:Disease-Free Survival; D019008:Drug Resistance, Neoplasm; D005260:Female; D006086:Graft vs Host Disease; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D013997:Time Factors; D018183:Transplantation Chimera; D019172:Transplantation Conditioning; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D000074323:Alemtuzumab