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.
BMT Service, Department of Haematology, Westmead Hospital, Westmead, New South Wales, Australia. mark_hertzberg@wmi.usyd.edu.au
M
M
Hertzberg
A
A
Grigg
D
D
Gottlieb
J
J
Szer
A
A
Roberts
R
R
Hoyt
G
G
Huang
K F
KF
Bradstock
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