Allogeneic transplantation after reduced-intensity conditioning with fludarabine-CY for both indolent and aggressive lymphoid malignancies.

Abstract

We studied the outcome of allo-SCT after reduced-intensity conditioning in relapsed or refractory indolent and aggressive lymphoid malignancies. All 54 patients (diagnosis: B-CLL n=13, indolent lymphoma n=12, aggressive lymphoma n=13, transformed lymphoma n=16) received conditioning with fludarabine and CY between July 2001 and November 2010. They underwent allo-SCT because of relapse after auto-SCT or because no other therapy could lead to a meaningful remission. Patients received an unmanipulated peripheral blood stem-cell graft. Median follow-up was 67 months. Thirty-two patients had received rituximab. Immediately after transplantation, remission status had improved in 21 patients, all without DLI. During the follow-up six additional patients achieved CR without further therapy. Four-year OS (EFS) was 46% (46%) for B-CLL, 83% (75%) for indolent lymphoma, 69% (55%) for aggressive lymphoma and 74% (67%) for transformed lymphoma (P=0.28 (P=0.54)). Forty two percent developed acute GVHD, 68% chronic GVHD (16% limited, 52% extensive). Previous auto-SCT did not influence OS, while acute GVHD did. Two-year non-relapse mortality was 16%. In conclusion, reduced-intensity conditioning with fludarabine-CY is feasible and effective for both indolent and aggressive lymphoid malignancies, even after previous auto-SCT. Because of the excellent anti-B-cell/lymphoma activity fludarabine-CY decreases tumor load, gaining time for the development of a graft versus lymphoma effect.

• Authors: M J Wondergem, F S Dijkstra, O J Visser, S Zweegman, G J Ossenkoppele, B I Witte, J J W M Janssen
• Journal: Bone marrow transplantation (Bone Marrow Transplant) Vol. 49 Issue 4 Pg. 513-8 (Apr 2014) ISSN: 1476-5365 [Electronic] England
• PMID: 24419517 (Publication Type: Journal Article)

Chemical References

• Cyclophosphamide
• Vidarabine
• fludarabine

Topics

• Adult
• Aged
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage)
• Cyclophosphamide (administration & dosage)
• Female
• Hematopoietic Stem Cell Transplantation (methods)
• Humans
• Leukemia, Lymphocytic, Chronic, B-Cell (drug therapy, therapy)
• Lymphoma (drug therapy, therapy)
• Male
• Middle Aged
• Retrospective Studies
• Transplantation Conditioning (methods)
• Transplantation, Homologous
• Vidarabine (administration & dosage, analogs & derivatives)