Reduced-intensity allogeneic haemopoietic stem cell transplantation induces durable responses in patients with chronic B-lymphoproliferative disorders.
Thirty-six patients with chronic B-lymphoproliferative disorders (B-LPD) underwent reduced-intensity allogeneic transplantation (RIT) from HLA-identical related donors. Diagnoses included follicular (n=17), mantle cell (n=9) and small lymphocytic lymphoma (n=2), and chronic lymphocytic leukaemia (n=8). Median age at transplant was 51 years (range, 30-66) and time from diagnosis was 3.4 years (range, 0.3-9.5). At transplant, 28% were in CR, 36% were in PR and 36% were chemorefractory. Conditioning therapy included fludarabine and either cyclophosphamide (n=27) or melphalan (n=9). Graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporin (CsA)/methotrexate (n=21), CsA/mycophenolate mofetil (n=13) or CsA alone (n=2). Eight patients died owing to acute GVHD (n=3), infection in association with chronic GVHD (n=4) and intra-abdominal bleeding (n=1). Treatment-related mortality was 8% at day 100, and 17 and 20% at one and two years, respectively. The cumulative incidence of grade II-IV acute GVHD was 58%, whereas limited and extensive chronic GVHD occurred in 25 and 56%, respectively. No patient has relapsed or progressed. At a median follow-up of 48 months, overall survival probability is 80% (95% CI, 67-93%). We confirm that RIT in chronic B-LPD can result in high and durable CR rates but with significant incidences of acute and chronic GVHD.
Hertzberg
M
M
BMT Service, Department of Haematology, Westmead Hospital, Westmead, New South Wales, Australia. mark_hertzberg@wmi.usyd.edu.au
Grigg
A
A
Gottlieb
D
D
Szer
J
J
Roberts
A
A
Hoyt
R
R
Huang
G
G
Bradstock
K F
KF
D000293:Adolescent; D000328:Adult; D000368:Aged; D001402:B-Lymphocytes / Q000378:metabolism*; D016572:Cyclosporine / Q000494:pharmacology; D005260:Female; D000069585:Filgrastim; D006086:Graft vs Host Disease / Q000378:metabolism; D016179:Granulocyte Colony-Stimulating Factor / Q000494:pharmacology; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006412:Hematopoietic Stem Cells / Q000166:cytology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology; D008232:Lymphoproliferative Disorders / Q000378:metabolism* / Q000628:therapy*; D008297:Male; D008727:Methotrexate / Q000494:pharmacology; D008875:Middle Aged; D011994:Recombinant Proteins; D012074:Remission Induction; D014184:Transplantation, Homologous / Q000379:methods
D007166:Immunosuppressive Agents; D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D016572:Cyclosporine; D000069585:Filgrastim; D008727:Methotrexate