Allogeneic hematopoietic transplantation for indolent lymphomas

improved outcome with non-myeloablative versus high dose chemotherapy (HDCT) regimens

Issa Khouri, Rima Saliba, Sergio Giralt, Fredrick Hagemeister, Martin Korbling, Anas Younes, James Gajewski, Naoto Ueno, Paolo Anderlini, Fernando Cabanillas, Richard Champlin

Research output: Contribution to journalArticle

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Abstract

Between 1990-1999, 58 patients with indolent lymphomas who failed conventional chemotherapy (small lymphocytic= 7, follicular small cleaved= 31, follicular mixed= 15. follicular large= 5) underwent allogeneic transplantation. Median age was 45 years (range 23-67). Thirty-seven were males. Median no. of prior chemo regimens was 2 (range 1 -9). At transplantation 21 (36%) had refractory disease. 44 patients received HDCT (TBIbased=24, BEAM=20) and 14 received nonmyeloablative stem cell transplantation (NST) using fludarabine 125mg/m2 over 5 days, cyclophosphamide 2gm/m2 over 2 days ±rituximab. NST was initiated in 1996 for older patients (50 years) or others with comorbidities. The median age for NST patients was 51 (range 31-67) compared to 43 (range 43 60) for who received HDCT (P= 0.008). There was no statistical difference between the two groups in: IPI distribution, M.D. Anderson Tumor Score, or no. of prior chemo regimens received. With a median follow-up of 30 mo (range, 2-79 mo), the outcome is as follows: NST HDCT P Day 100 mortality 0.34% 0.02 GII-rVGVHD 7% 43% 0.01 Gffl-IVGVHD 0% 20.5% 0.07 Overall survival (OS) (2yrs) 73% 45% 0.05 Disease free survival (DPS) (2yrs) 73% 43% 0.02 The proportion of pts who had refractory disease at the time of transplant was higher in the HDCT than in the NST arm (43% vs 14%, P= 0.05). To circumvent this difference, we analyzed the outcome for only patients who had sensitive disease in both arms. The OS and DPS for NST were both 100% and were both 36% for HDCT (P= 0.004, 95%, CI 15-37). Although whether this approach is optimal for patients with refractory disease is unknown, we conclude that NST is superior to HDCT especially in patients with sensitive disease. This treatment should be considered for patients with indolent lymphomas who fail prior conventional treatment.

Original languageEnglish (US)
JournalBlood
Volume96
Issue number11 PART I
StatePublished - 2000
Externally publishedYes

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Chemotherapy
Homologous Transplantation
Stem cells
Stem Cell Transplantation
Lymphoma
Drug Therapy
Refractory materials
Arm
Transplants
Survival
Cyclophosphamide
Tumors
Disease-Free Survival
Comorbidity
Transplantation
Mortality
Therapeutics

ASJC Scopus subject areas

  • Hematology

Cite this

Khouri, I., Saliba, R., Giralt, S., Hagemeister, F., Korbling, M., Younes, A., ... Champlin, R. (2000). Allogeneic hematopoietic transplantation for indolent lymphomas: improved outcome with non-myeloablative versus high dose chemotherapy (HDCT) regimens. Blood, 96(11 PART I).

Allogeneic hematopoietic transplantation for indolent lymphomas : improved outcome with non-myeloablative versus high dose chemotherapy (HDCT) regimens. / Khouri, Issa; Saliba, Rima; Giralt, Sergio; Hagemeister, Fredrick; Korbling, Martin; Younes, Anas; Gajewski, James; Ueno, Naoto; Anderlini, Paolo; Cabanillas, Fernando; Champlin, Richard.

In: Blood, Vol. 96, No. 11 PART I, 2000.

Research output: Contribution to journalArticle

Khouri, I, Saliba, R, Giralt, S, Hagemeister, F, Korbling, M, Younes, A, Gajewski, J, Ueno, N, Anderlini, P, Cabanillas, F & Champlin, R 2000, 'Allogeneic hematopoietic transplantation for indolent lymphomas: improved outcome with non-myeloablative versus high dose chemotherapy (HDCT) regimens', Blood, vol. 96, no. 11 PART I.
Khouri, Issa ; Saliba, Rima ; Giralt, Sergio ; Hagemeister, Fredrick ; Korbling, Martin ; Younes, Anas ; Gajewski, James ; Ueno, Naoto ; Anderlini, Paolo ; Cabanillas, Fernando ; Champlin, Richard. / Allogeneic hematopoietic transplantation for indolent lymphomas : improved outcome with non-myeloablative versus high dose chemotherapy (HDCT) regimens. In: Blood. 2000 ; Vol. 96, No. 11 PART I.
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abstract = "Between 1990-1999, 58 patients with indolent lymphomas who failed conventional chemotherapy (small lymphocytic= 7, follicular small cleaved= 31, follicular mixed= 15. follicular large= 5) underwent allogeneic transplantation. Median age was 45 years (range 23-67). Thirty-seven were males. Median no. of prior chemo regimens was 2 (range 1 -9). At transplantation 21 (36{\%}) had refractory disease. 44 patients received HDCT (TBIbased=24, BEAM=20) and 14 received nonmyeloablative stem cell transplantation (NST) using fludarabine 125mg/m2 over 5 days, cyclophosphamide 2gm/m2 over 2 days ±rituximab. NST was initiated in 1996 for older patients (50 years) or others with comorbidities. The median age for NST patients was 51 (range 31-67) compared to 43 (range 43 60) for who received HDCT (P= 0.008). There was no statistical difference between the two groups in: IPI distribution, M.D. Anderson Tumor Score, or no. of prior chemo regimens received. With a median follow-up of 30 mo (range, 2-79 mo), the outcome is as follows: NST HDCT P Day 100 mortality 0.34{\%} 0.02 GII-rVGVHD 7{\%} 43{\%} 0.01 Gffl-IVGVHD 0{\%} 20.5{\%} 0.07 Overall survival (OS) (2yrs) 73{\%} 45{\%} 0.05 Disease free survival (DPS) (2yrs) 73{\%} 43{\%} 0.02 The proportion of pts who had refractory disease at the time of transplant was higher in the HDCT than in the NST arm (43{\%} vs 14{\%}, P= 0.05). To circumvent this difference, we analyzed the outcome for only patients who had sensitive disease in both arms. The OS and DPS for NST were both 100{\%} and were both 36{\%} for HDCT (P= 0.004, 95{\%}, CI 15-37). Although whether this approach is optimal for patients with refractory disease is unknown, we conclude that NST is superior to HDCT especially in patients with sensitive disease. This treatment should be considered for patients with indolent lymphomas who fail prior conventional treatment.",
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T2 - improved outcome with non-myeloablative versus high dose chemotherapy (HDCT) regimens

AU - Khouri, Issa

AU - Saliba, Rima

AU - Giralt, Sergio

AU - Hagemeister, Fredrick

AU - Korbling, Martin

AU - Younes, Anas

AU - Gajewski, James

AU - Ueno, Naoto

AU - Anderlini, Paolo

AU - Cabanillas, Fernando

AU - Champlin, Richard

PY - 2000

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N2 - Between 1990-1999, 58 patients with indolent lymphomas who failed conventional chemotherapy (small lymphocytic= 7, follicular small cleaved= 31, follicular mixed= 15. follicular large= 5) underwent allogeneic transplantation. Median age was 45 years (range 23-67). Thirty-seven were males. Median no. of prior chemo regimens was 2 (range 1 -9). At transplantation 21 (36%) had refractory disease. 44 patients received HDCT (TBIbased=24, BEAM=20) and 14 received nonmyeloablative stem cell transplantation (NST) using fludarabine 125mg/m2 over 5 days, cyclophosphamide 2gm/m2 over 2 days ±rituximab. NST was initiated in 1996 for older patients (50 years) or others with comorbidities. The median age for NST patients was 51 (range 31-67) compared to 43 (range 43 60) for who received HDCT (P= 0.008). There was no statistical difference between the two groups in: IPI distribution, M.D. Anderson Tumor Score, or no. of prior chemo regimens received. With a median follow-up of 30 mo (range, 2-79 mo), the outcome is as follows: NST HDCT P Day 100 mortality 0.34% 0.02 GII-rVGVHD 7% 43% 0.01 Gffl-IVGVHD 0% 20.5% 0.07 Overall survival (OS) (2yrs) 73% 45% 0.05 Disease free survival (DPS) (2yrs) 73% 43% 0.02 The proportion of pts who had refractory disease at the time of transplant was higher in the HDCT than in the NST arm (43% vs 14%, P= 0.05). To circumvent this difference, we analyzed the outcome for only patients who had sensitive disease in both arms. The OS and DPS for NST were both 100% and were both 36% for HDCT (P= 0.004, 95%, CI 15-37). Although whether this approach is optimal for patients with refractory disease is unknown, we conclude that NST is superior to HDCT especially in patients with sensitive disease. This treatment should be considered for patients with indolent lymphomas who fail prior conventional treatment.

AB - Between 1990-1999, 58 patients with indolent lymphomas who failed conventional chemotherapy (small lymphocytic= 7, follicular small cleaved= 31, follicular mixed= 15. follicular large= 5) underwent allogeneic transplantation. Median age was 45 years (range 23-67). Thirty-seven were males. Median no. of prior chemo regimens was 2 (range 1 -9). At transplantation 21 (36%) had refractory disease. 44 patients received HDCT (TBIbased=24, BEAM=20) and 14 received nonmyeloablative stem cell transplantation (NST) using fludarabine 125mg/m2 over 5 days, cyclophosphamide 2gm/m2 over 2 days ±rituximab. NST was initiated in 1996 for older patients (50 years) or others with comorbidities. The median age for NST patients was 51 (range 31-67) compared to 43 (range 43 60) for who received HDCT (P= 0.008). There was no statistical difference between the two groups in: IPI distribution, M.D. Anderson Tumor Score, or no. of prior chemo regimens received. With a median follow-up of 30 mo (range, 2-79 mo), the outcome is as follows: NST HDCT P Day 100 mortality 0.34% 0.02 GII-rVGVHD 7% 43% 0.01 Gffl-IVGVHD 0% 20.5% 0.07 Overall survival (OS) (2yrs) 73% 45% 0.05 Disease free survival (DPS) (2yrs) 73% 43% 0.02 The proportion of pts who had refractory disease at the time of transplant was higher in the HDCT than in the NST arm (43% vs 14%, P= 0.05). To circumvent this difference, we analyzed the outcome for only patients who had sensitive disease in both arms. The OS and DPS for NST were both 100% and were both 36% for HDCT (P= 0.004, 95%, CI 15-37). Although whether this approach is optimal for patients with refractory disease is unknown, we conclude that NST is superior to HDCT especially in patients with sensitive disease. This treatment should be considered for patients with indolent lymphomas who fail prior conventional treatment.

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