Nonmyeloablative stem cell transplantation for lymphoma.

Abstract	High-dose chemotherapy and allogeneic stem cell transplantation is a potentially curative therapy for younger patients with non-Hodgkin's lymphoma (NHL). The benefits of this therapy, however, are largely offset by the high rate of treatment-related mortality, exceeding 40% in many studies. Risks increase with comorbidities, advanced age, histocompatibility, and disease-related prognostic factors. Given the potential efficacy of graft-versus-malignancy effects against many lymphoid malignancies, we evaluated an alternative strategy utilizing less toxic, nonmyeloablative conditioning regimens to allow engraftment of donor cells, and then exploit the graft-versus-lymphoma (GVL) effects of allogeneic transplantation as the primary therapy. This strategy involved fludarabine-based preparative regimens +/- high-dose rituximab, graft-versus-host disease (GVHD) prophylaxis for 6 months, and donor lymphocyte infusion (DLI) only for progressive or nonresponding disease. Results from these trials confirm the full potential on nonmyeloablative transplantation for patients with NHL.
Authors	Issa F Khouri, Richard E Champlin
Journal	Seminars in oncology (Semin Oncol) Vol. 31 Issue 1 Pg. 22-6 (Feb 2004) ISSN: 0093-7754 [Print] United States
PMID	14970933 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)
Chemical References	Antibodies, Monoclonal Antibodies, Monoclonal, Murine-Derived Immunosuppressive Agents Rituximab Cyclophosphamide Vidarabine fludarabine
Topics	Adult Aged Antibodies, Monoclonal (administration & dosage) Antibodies, Monoclonal, Murine-Derived Antineoplastic Combined Chemotherapy Protocols (therapeutic use) Cyclophosphamide (administration & dosage) Drug Administration Schedule Graft vs Host Disease (prevention & control) Humans Immunosuppressive Agents (therapeutic use) Lymphoma (mortality, therapy) Middle Aged Recurrence Rituximab Stem Cell Transplantation (methods) Survival Rate Transplantation Conditioning (methods) Vidarabine (analogs & derivatives, therapeutic use)

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