title: Eight-year experience with allogeneic stem cell transplantation for relapsed follicular lymphoma after nonmyeloablative conditioning with fludarabine, cyclophosphamide, and rituximab.
abstract: Nonmyeloablative stem cell transplantation in patients with follicular lymphoma has been designed to exploit the graft-versus-lymphoma immunity. The long-term effectiveness and toxicity of this strategy, however, is unknown. In this prospective study, we analyzed our 8-year experience. Patients received a conditioning regimen of fludarabine (30 mg/m(2) daily for 3 days), cyclophosphamide (750 mg/m(2) daily for 3 days), and rituximab (375 mg/m(2) for 1 day plus 1000 mg/m(2) for 3 days). They were then given an infusion of human leukocyte antigen-matched hematopoietic cells from related (n = 45) or unrelated donors (n = 2). Tacrolimus and methotrexate were used for graft-versus-host disease (GVHD) prophylaxis. Forty-seven patients were included. All patients experienced complete remission, with only 2 relapses. With a median follow-up time of 60 months (range, 19-94), the estimated survival and progression-free survival rates were 85% and 83%, respectively. All 18 patients who were tested and had evidence of JH/bcl-2 fusion transcripts in the bone marrow at study entry experienced continuous molecular remission. The incidence of grade 2-IV acute GVHD was 11%. Only 5 patients were still undergoing immunosuppressive therapy at the time of last follow-up. We believe that the described results are a step forward toward developing a curative strategy for recurrent follicular lymphoma.
authors.affiliation: Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M. D. Anderson Cancer Center, Houston 77030, USA. ikhouri@mdanderson.org
authors.forename: Issa F
authors.initials: IF
authors.lastname: Khouri
authors.forename: Peter
authors.initials: P
authors.lastname: McLaughlin
authors.forename: Rima M
authors.initials: RM
authors.lastname: Saliba
authors.forename: Chitra
authors.initials: C
authors.lastname: Hosing
authors.forename: Martin
authors.initials: M
authors.lastname: Korbling
authors.forename: Ming S
authors.initials: MS
authors.lastname: Lee
authors.forename: L Jeffrey
authors.initials: LJ
authors.lastname: Medeiros
authors.forename: Luis
authors.initials: L
authors.lastname: Fayad
authors.forename: Felipe
authors.initials: F
authors.lastname: Samaniego
authors.forename: Amin
authors.initials: A
authors.lastname: Alousi
authors.forename: Paolo
authors.initials: P
authors.lastname: Anderlini
authors.forename: Daniel
authors.initials: D
authors.lastname: Couriel
authors.forename: Marcos
authors.initials: M
authors.lastname: de Lima
authors.forename: Sergio
authors.initials: S
authors.lastname: Giralt
authors.forename: Sattva S
authors.initials: SS
authors.lastname: Neelapu
authors.forename: Naoto T
authors.initials: NT
authors.lastname: Ueno
authors.forename: Barry I
authors.initials: BI
authors.lastname: Samuels
authors.forename: Fredrick
authors.initials: F
authors.lastname: Hagemeister
authors.forename: Larry W
authors.initials: LW
authors.lastname: Kwak
authors.forename: Richard E
authors.initials: RE
authors.lastname: Champlin
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000009:adverse effects; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects; D001402:B-Lymphocytes / Q000166:cytology; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease; D020350:Graft vs Tumor Effect; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008224:Lymphoma, Follicular / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D012008:Recurrence; D012074:Remission Induction; D000069283:Rituximab; D015996:Survival Rate; D018183:Transplantation Chimera; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous; D014740:Vidarabine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D019653:Myeloablative Agonists; D000069283:Rituximab; D003520:Cyclophosphamide; D014740:Vidarabine; C024352:fludarabine