title: T-cell replete fludarabine/cyclophosphamide reduced intensity allogeneic stem cell transplantation for lymphoid malignancies.
abstract: The relative merits of reduced-intensity allogeneic stem cell transplantation (RISCT) for high-risk indolent lymphoid malignancies are emerging, although the preferred conditioning regimen to manage the risks of graft-versus-host disease (GVHD) is not clearly defined. Here we report the outcome of 73 patients with lymphoid malignancies who received RISCT with a fludarabine/cyclophosphosphamide conditioning regimen and a median follow-up of 3 years. Median age was 54 years. Forty-eight per cent of patients had previously undergone autologous stem cell transplantation with a median of three prior therapies. Non-relapse mortality at 3 years was 19% but only 5% for patients with multiple myeloma (MM). Three-year overall survival and current progression-free survival was 67% and 63% respectively. Grade 2-4 acute GVHD occurred in 14% of patients while 49% had chronic GVHD requiring systemic immunosuppression. The preparatory regimen in this study has the advantage of reduced acute GVHD and low mortality, notably in patients with MM. In addition, this strategy provides long-term disease control in a significant proportion of patients with particular benefit in those with high-risk follicular lymphoma.
authors.affiliation: Department of Haemato-Oncology, St Bartholomew's Hospital, London, UK. r.l.auer@qmul.ac.uk
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Auer
authors.forename: Finlay
authors.initials: F
authors.lastname: MacDougall
authors.forename: Heather E
authors.initials: HE
authors.lastname: Oakervee
authors.forename: David
authors.initials: D
authors.lastname: Taussig
authors.forename: Jeff K
authors.initials: JK
authors.lastname: Davies
authors.forename: Denise
authors.initials: D
authors.lastname: Syndercombe-Court
authors.forename: Samir
authors.initials: S
authors.lastname: Agrawal
authors.forename: Jamie D
authors.initials: JD
authors.lastname: Cavenagh
authors.forename: T Andrew
authors.initials: TA
authors.lastname: Lister
authors.forename: John G
authors.initials: JG
authors.lastname: Gribben
mesh_terms: D000328:Adult; D000368:Aged; D003520:Cyclophosphamide / Q000008:administration & dosage*; D006086:Graft vs Host Disease / Q000188:drug therapy / Q000209:etiology; D019337:Hematologic Neoplasms / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D008232:Lymphoproliferative Disorders / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D008875:Middle Aged; D012008:Recurrence; D016019:Survival Analysis; D013601:T-Lymphocytes / Q000276:immunology; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D003520:Cyclophosphamide; D014740:Vidarabine; C024352:fludarabine