Allogeneic bone marrow transplantation for low-grade lymphoma and chronic lymphocytic leukemia

Abstract

Summary:Twenty-six patients with low-grade lymphoma (LGL) (n ‫؍‬ 18) or chronic lymphocytic leukemia (CLL) (n ‫؍‬ 8) received allogeneic BMTs between 1985 and 1998. Median age was 42 years, median interval from diagnosis to transplant 22 months and median number of prior treatments three. Twenty (77%) had stage IV disease; 22 (85%) had never achieved CR. Donor source was HLA matched sibling (n ‫؍‬ 19, 73%), matched unrelated (n ‫؍‬ 6, 23%) or syngeneic (n ‫؍‬ 1). Conditioning therapy included total body irradiation in 23 patients and busulphan in three. Twenty-five received GVHD prophylaxis with cyclosporine A; ؉ methotrexate (n ‫؍‬ 19), ؉ methylprednisolone (n ‫؍‬ 2) or ؉ T cell depletion of allograft ؎ methotrexate (n ‫؍‬ 4). Sixteen patients are alive, a median of 2.4 years post BMT. Death occurred due to transplant complications (n ‫؍‬ 7) or underlying disease (n ‫؍‬ 3). Eighteen (12 LGL, six CLL) of 22 evaluable patients (82%) achieved CR post BMT. Cumulative incidence of refractory/recurrent disease was 18% (95% confidence interval (CI) 7-42%). Overall and event-free survivals were 58% (95% CI 35-75%) and 54% (95% CI 32-72%), respectively. Allogeneic BMT for young patients with advanced LGL or CLL is feasible and can result in long-term disease-free survival. Bone Marrow Transplantation (2000) 25, 605-612. Keywords: low-grade lymphoma; chronic lymphocytic leukemia; allogeneic bone marrow transplantation Low-grade lymphoma (LGL) and chronic lymphocytic leukemia (CLL) are indolent hematologic malignancies with median survival times approaching a decade.1-5 Although clinical remission can be achieved with standard 6-9 and newer 10-14 therapies, prolonged freedom from recurrence has not been demonstrated for patients with advanced stage, making death from disease almost inevitable. 8,9,11,[13][14][15][16] for younger patients, particularly those with refractory or recurrent disease, a more aggressive approach to treatment can be justified. 17-20High-dose therapy with allogeneic stem cell support is an attractive option for such patients, where marrow involvement is common and the occurrence of a graftversus-leukemia/lymphoma (GVL) effect 21-26 may contribute to the achievement of long-term disease control. Worldwide experience with allogeneic transplantation in this setting is, however, still limited. We report results from 26 patients with LGL or CLL receiving allogeneic BMT at the Vancouver General Hospital since 1985. Patients and methods PatientsTwenty-six patients with LGL (n ϭ 18) or CLL (n ϭ 8) received allogeneic BMT between September 1985 and January 1998, during which time, a total of 589 allografts and 512 autografts were performed in adults by the Leukemia/BMT Program of British Columbia. Eligibility criteria included: (1) age р50-55 years (related donor) and р45-50 years (unrelated donor); (2) Karnofsky performance score (KPS) у80%; and (3) adequate pre-transplant organ function including left ventricular ejection fraction у40%, forced expiratory volume in 1 s у60% and diffusing capacity for car...

Allogeneic peripheral blood stem cell transplantation for high-risk non-Hodgkin's lymphoma

“…[1][2][3][4][5][6] The latter problem has resulted in the exclusion of most older patients and those with comorbid disease. Similarly, even in younger, healthier patients who have relapsed after an autologous transplant, allogeneic transplantation with standard conditioning has been associated with a prohibitive risk of treatment-related mortality (TRM).…”

Allogeneic hematopoietic stem cell transplantation for progressive follicular lymphoma

“…17 In keeping with this hypothesis, previous reports of allogeneic HSCT for patients with follicular lymphoma have confirmed a low rate of relapse. 10,12,14,[18][19][20][21][22][23] Despite encouraging results, the experience with allogeneic HSCT for follicular lymphoma remains limited due to both the indolent nature of the disease and the advanced age of the majority of patients when diagnosed. Indeed, several factors may limit the applicability of allogeneic HSCT to a minority of patients with advanced follicular lymphoma and potentially bias results in favor of HSCT over conventional treatments.…”

Long-term clinical and molecular remission after allogeneic stem cell transplantation (SCT) in patients with poor prognosis non-Hodgkin's lymphoma

“…The median time to reach more than 0.5 × 10 9 /l ANC was 16 (range, [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] …”

“…[12][13][14][15] Nevertheless, some patients with poor prognosis NHL attain long-term clinical remissions. [16][17][18][19][20] As other hematologic malignances NHLs are characterized by non-random genetic alterations. A clonal IgH rearrangement can be detected in the majority of patients with NHL and about 90% of follicular lymphomas and some diffuse large B cell lymphomas are characterized by the t(14;18).…”