title: Immunomodulatory nonablative conditioning regimen for B-cell lymphoid malignancies.
abstract: Twenty-six patients with recurrent CD20(+) B-cell lymphoid malignancies received fludarabine, cyclophosphamide, and rituximab-based nonablative conditioning followed by either matched related (n = 18) or unrelated (n = 8) donor allogeneic stem cell transplantation (allo-SCT) between March 2008 and May 2011. Median age of patients at transplantation was 59 years (range, 41-64 years). At diagnosis, 20 (77%) had stage IV disease; 23 (88%) received ≥3 regimens, 14 (54%) received ≥4 regimens, and 4 (15%) had earlier autologous-SCT. All patients had either chemosensitive or stable disease and nine (35%) were in complete remission before transplantation. At the time of analysis, 17 patients were alive with an estimated 2-year overall survival and progression-free survival rate of 63% and nonrelapse mortality of 25%. Grade II to IV acute graft-vs-host-disease occurred in 8 (31%) and chronic graft-vs-host-disease in 6 (23%) patients (extensive, n = 3). Causes of death include progressive disease in four, acute graft-vs-host-disease in two (both after receiving donor lymphocyte infusion for mixed chimerism with residual disease), infection in one, and other (e.g., substance abuse, leukoencephalopathy) in two. Six patients required rehospitalization within 100 days of SCT (mean = 10 days; range, 3-18 days). Our data support fludarabine, cyclophosphamide, and rituximab-based nonablative conditioning allo-SCT in CD20(+) B-cell lymphoid malignancies and it is time to compare this regimen with an alternative reduced-intensity conditioning regimen in B-cell malignancies.
authors.affiliation: Hematology and Stem Cell Transplantation Section, Division of Hematology/Oncology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
authors.forename: Wichai
authors.initials: W
authors.lastname: Chinratanalab
authors.forename: Nishitha
authors.initials: N
authors.lastname: Reddy
authors.forename: John P
authors.initials: JP
authors.lastname: Greer
authors.forename: David
authors.initials: D
authors.lastname: Morgan
authors.forename: Brian
authors.initials: B
authors.lastname: Engelhardt
authors.forename: Adetola
authors.initials: A
authors.lastname: Kassim
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Brandt
authors.forename: Madan
authors.initials: M
authors.lastname: Jagasia
authors.forename: Stacey
authors.initials: S
authors.lastname: Goodman
authors.forename: Bipin N
authors.initials: BN
authors.lastname: Savani
mesh_terms: D000328:Adult; D018951:Antigens, CD20 / Q000276:immunology; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D004854:Herpesvirus 4, Human / Q000502:physiology; D006801:Humans; D016393:Lymphoma, B-Cell / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D016019:Survival Analysis; D019172:Transplantation Conditioning; D016896:Treatment Outcome; D014775:Virus Activation
chemical_list: D018951:Antigens, CD20