Busulfan and cyclophosphamide as a preparative regimen for allogeneic blood and marrow transplantation in patients with non-Hodgkin's lymphoma

Abstract

Summary:This study reports on overall and recurrence-free survival (OS and RFS) of 37 consecutive patients with low-and intermediate-grade NHL receiving a related donor allogeneic BMT using a nonradiation-containing preparative regimen. In addition, transplant-related toxicity and factors influencing outcome are discussed. The preparative regimen consisted of busulfan and cyclophosphamide. Median patient age was 44 years (range 20-55). In all, 18 were female. Median follow-up of surviving patients from BMT was 4.2 years. A total of 25 patients had low-grade, and 12 intermediate grade NHL. Most patients (89%) were treated with at least two different chemotherapy regimens prior to BMT. In all, 22 patients (59%) were transplanted in partial remission, 15 (41%) in complete remission. OS at 12 months was 89% (95% confidence interval (CI) of 79-99%) and 79% (64-93%) at 60 months. RFS at 12 months was 86% (75-97%) and at 5 years 70% (54-86%). Four patients (11%) relapsed. Seven patients (19%) died, six because of treatmentrelated toxicity and one with relapse. Univariate analysis showed improved OS for younger patients and patients of female gender, suggesting that allogeneic BMT using busulfan-cyclophosphamide as a preparative regimen can achieve disease control and possibly cure patients with NHL particularly younger ones.

Autologous SCT with a dose-reduced BU and CY regimen in older patients with non-Hodgkin's lymphoma

“…11 The regimen of BU and CY has been described extensively in several patient groups as a conditioning regimen for both autologous and allogeneic SCT for the treatment of hematologic malignancies. [12][13][14][15] The efficacy and side effects of this regimen have not been extensively studied in patients more than 60 years of age with NHL undergoing SCT, and there are little data on the outcomes of patients greater than 70 years old.…”

Evidence of graft-versus-Waldenstrom's macroglobulinaemia effect after allogeneic stem cell transplantation: a single centre experience

“…Our previous work in allogeneic transplant outcomes for follicular lymphoma using busulphan plus cyclophosphamide conditioning reported 89 and 79% overall survival at 1 and 5 years with six non-relapse mortality cases (6/37, 16%). 24 This conditioning uses a nonirradiation-based regimen, which possibly results in a decrease in tissue damage, and might ultimately contribute to a lower transplant-related mortality. Presently, however, there is no published evidence with respect to WM, to suggest superiority of one conditioning regimen over another.…”

Current First-line and Salvage Treatment Strategies in Patients with Advanced-stage Follicular Lymphoma

“…54,[61][62][63][64][65][66][67][68][69][70][71][72][73][74] These data show that this treatment modality may have the potential for cure in relapsed/refractory FL, shown by low recurrence rates after transplant (0-25%), although long-term followup data for allogeneic HSCT are still pending. However, the high TRM (20-40%) due to fatal graft versus host disease (GvHD) and infection is still a matter for concern with this type of transplantation, limiting its use to patients <50 years of age.…”