Reduced-intensity allogeneic haemopoietic stem cell transplantation induces durable responses in patients with chronic B-lymphoproliferative disorders

Bone Marrow Transplant. 2006 May;37(10):923-8. doi: 10.1038/sj.bmt.1705357.

Abstract

Thirty-six patients with chronic B-lymphoproliferative disorders (B-LPD) underwent reduced-intensity allogeneic transplantation (RIT) from HLA-identical related donors. Diagnoses included follicular (n=17), mantle cell (n=9) and small lymphocytic lymphoma (n=2), and chronic lymphocytic leukaemia (n=8). Median age at transplant was 51 years (range, 30-66) and time from diagnosis was 3.4 years (range, 0.3-9.5). At transplant, 28% were in CR, 36% were in PR and 36% were chemorefractory. Conditioning therapy included fludarabine and either cyclophosphamide (n=27) or melphalan (n=9). Graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporin (CsA)/methotrexate (n=21), CsA/mycophenolate mofetil (n=13) or CsA alone (n=2). Eight patients died owing to acute GVHD (n=3), infection in association with chronic GVHD (n=4) and intra-abdominal bleeding (n=1). Treatment-related mortality was 8% at day 100, and 17 and 20% at one and two years, respectively. The cumulative incidence of grade II-IV acute GVHD was 58%, whereas limited and extensive chronic GVHD occurred in 25 and 56%, respectively. No patient has relapsed or progressed. At a median follow-up of 48 months, overall survival probability is 80% (95% CI, 67-93%). We confirm that RIT in chronic B-LPD can result in high and durable CR rates but with significant incidences of acute and chronic GVHD.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • B-Lymphocytes / metabolism*
  • Cyclosporine / pharmacology
  • Female
  • Filgrastim
  • Graft vs Host Disease / metabolism
  • Granulocyte Colony-Stimulating Factor / pharmacology
  • Hematopoietic Stem Cell Transplantation / methods*
  • Hematopoietic Stem Cells / cytology*
  • Humans
  • Immunosuppressive Agents / pharmacology
  • Lymphoproliferative Disorders / metabolism*
  • Lymphoproliferative Disorders / therapy*
  • Male
  • Methotrexate / pharmacology
  • Middle Aged
  • Recombinant Proteins
  • Remission Induction
  • Transplantation, Homologous / methods

Substances

  • Immunosuppressive Agents
  • Recombinant Proteins
  • Granulocyte Colony-Stimulating Factor
  • Cyclosporine
  • Filgrastim
  • Methotrexate