Allogeneic stem cell transplantation with T cell-depleted grafts for lymphoproliferative malignancies.
In non-Hodgkin lymphoma allogeneic stem cell transplantation (SCT) can be curative, but with standard dose conditioning patients may have substantial morbidity and mortality from graft-versus-host disease (GVHD); for aggressive malignancies, reduced intensity conditioning may result in higher recurrence. Patients with advanced follicular lymphoma (n = 12), transformed B cell malignancy (n = 11), and non-CD30+T cell lymphomas (n = 17) responsive to chemotherapy who had an HLA-identical sibling were offered T cell depleted (CAMPATH-1 G or H antibodies) SCT. Conditioning was with ablative doses of chemotherapy or radiotherapy. Before SCT, patients with follicular lymphoma had a median of 3 treatment courses, and those with transformed B cell and those diagnosed with T cell non-Hodgkin lymphoma had 2 (range, 1-3). At SCT the median age was 46 years (range, 21-59 years) and the number of CD34+ cells infused was 2.85 x 10(6)/kg. All patients showed engraftment but 7 patients (17.5%) developed GVHD. In total 12 subjects expired of transplant-related causes (n = 6) or from disease recurrence. One-year transplant-related mortality was 15%. There was no difference in survival across diagnostic groups. At a median of 1051 days, 70% survived and 68% are without disease. By reducing the incidence and severity of GVHD, patients can tolerate myeloablative doses of chemotherapy satisfactorily. This has resulted in low treatment-related mortality and adequate protection from disease recurrence.
Novitzky
Nicolas
N
University of Cape Town Leukaemia Centre and Department of Haematology, Groote Schuur Hospital, Cape Town, Western Cape, South Africa. novitzky@cormack.uct.ac.za
Thomas
Valda
V
D000293:Adolescent; D000328:Adult; D000074323:Alemtuzumab; D000911:Antibodies, Monoclonal / Q000494:pharmacology; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm / Q000494:pharmacology; D016026:Bone Marrow Transplantation; D018572:Disease-Free Survival; D006086:Graft vs Host Disease; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008212:Lymphocyte Depletion / Q000379:methods*; D008228:Lymphoma, Non-Hodgkin / Q000628:therapy*; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation; D035781:Siblings; D019172:Transplantation Conditioning / Q000379:methods; D014184:Transplantation, Homologous
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D000074323:Alemtuzumab