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

Abstract

Summary:A high incidence of nonrelapse mortality (NRM) has limited the use of allogeneic transplantation for poor prognosis non-Hodgkin's lymphoma (NHL). We sought to improve the outcome of allografting by utilizing Filgrastim-mobilized peripheral blood stem cells (PBSC) in combination with either standard ablative or reducedintensity conditioning. A total of 21 patients with intermediate/high-grade lymphoma and seven patients with low-grade histology were enrolled on protocols using PBSC. All patients were considered high risk for recurrence and/or NRM because of age 450 (n ¼ 16), refractory disease (n ¼ 17), failed autologous transplant (n ¼ 11) and abnormal organ function (n ¼ 2). In all, 17 patients received ablative regimens and 11 received modified conditioning including fludarabine, intravenous busulfan and ATG. Tacrolimus and mini-dose methotrexate were used for graft-versus-host-disease (GVHD) prophylaxis. Median follow-up was 38 months. Diseasefree and overall survival were 57 and 58%. Seven of the 11 patients who relapsed after a previous transplant remain disease free. Four of the 10 patients with recurrent/ persistent disease post transplant responded to additional therapy including withdrawal of immunosuppression7 DLI. These results support a potent graft-versus-lymphoma effect and suggest that patients who relapse after an autologous transplant can be salvaged with an allogeneic transplant.

Allogeneic SCT for relapsed composite and transformed lymphoma using related and unrelated donors: long-term results

“…Relapse risk is however higher in this population than that seen with myeloablative allografting in indolent NHL, and approaches the relapse risk for chemoresistant aggressive NHL. 16,21,38,39 Moreover, treatment-related mortality for patients in our study appears to be higher than that seen for either indolent or aggressive NHL patients proceeding to myeloablative allograft. 16,38 These data suggest that although allo-SCT may rescue a proportion of patients with transformed and composite lymphoma, more ideal strategies would include use of therapy designed to prevent transformation and early application of allo-SCT to patients with indolent NHL at high risk of transformation.…”

High-dose treosulfan in patients with relapsed or refractory high-grade lymphoma receiving tandem autologous blood stem cell transplantation

“…[27][28][29] Further, the monoclonal antibody rituximab has the potential to improve the treatment results in relapsed or refractory B-cell lymphoma on several levels; first, at initial cytoreductive treatment for rapid induction of remission, second, for in vivo stem cell purging, and lastly, during or after HDT for the maintenance of remission. [30][31][32] In conclusion, the feasibility to include treosulfan into a high-dose combination regimen has been demonstrated.…”

Second hematopoietic SCT for lymphoma patients who relapse after autotransplantation: another autograft or switch to allograft?

“…15,31,[38][39][40][41][42][43][44][45][46] Many publications come from single-institution studies involving small numbers of patients. 15,31,38 Most communications describe a TRM as high as 80% and a high risk of GVHD; however, selected patients attained durable remissions without the need for further therapy.…”