title: Allogeneic haematopoietic cell transplantation after nonmyeloablative conditioning in patients with T-cell and natural killer-cell lymphomas.
abstract: Patients with T-cell and natural killer-cell lymphomas have poor outcomes. This study examined the role of allogeneic haematopoietic cell transplantation (allo-HCT) after nonmyeloablative conditioning in this setting. Seventeen patients with T-cell lymphoma or NK-cell lymphoma, including three patients in first complete remission, received allo-HCT after 2 Gy total-body irradiation and fludarabine. The median age was 57 (range, 18-73) years. The median number of prior therapies was 3 (range, 1-7), six patients (35%) had failed prior autologous HCT, and five patients (29%) had refractory disease at the time of allograft. Postgrafting immunosuppression was provided with mycophenolate mofetil with ciclosporin or tacrolimus. After a median follow-up of 3.3 (range, 0.3-8.0) years among surviving patients, the estimated probabilities of 3-year overall and progression-free survival were 59% and 53%, respectively, while the estimated probabilities of non-relapse mortality and relapse at 3 years were 19% and 26%, respectively. Sixty-five percent of patients developed grades 2-4 acute graft-versus-host disease and 53% of patients developed chronic graft-versus-host disease. Allo-HCT after nonmyeloablative conditioning is a promising salvage option for selected patients with T-cell and NK-cell lymphomas. These results suggest that graft-versus-T-cell lymphoma activity is responsible for long-term disease control.
authors.affiliation: University of Washington, Seattle, WA, USA. ashustov@fhcrc.org
authors.forename: Andrei R
authors.initials: AR
authors.lastname: Shustov
authors.forename: Theodore A
authors.initials: TA
authors.lastname: Gooley
authors.forename: Brenda M
authors.initials: BM
authors.lastname: Sandmaier
authors.forename: Judith
authors.initials: J
authors.lastname: Shizuru
authors.forename: Mohamed L
authors.initials: ML
authors.lastname: Sorror
authors.forename: Firoozeh
authors.initials: F
authors.lastname: Sahebi
authors.forename: Peter
authors.initials: P
authors.lastname: McSweeney
authors.forename: Dietger
authors.initials: D
authors.lastname: Niederwieser
authors.forename: Benedetto
authors.initials: B
authors.lastname: Bruno
authors.forename: Rainer
authors.initials: R
authors.lastname: Storb
authors.forename: David G
authors.initials: DG
authors.lastname: Maloney
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D018450:Disease Progression; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000209:etiology; D020350:Graft vs Tumor Effect; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006650:Histocompatibility Testing; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007694:Killer Cells, Natural / Q000473:pathology; D016399:Lymphoma, T-Cell / Q000276:immunology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult