Nonablative allogeneic hematopoietic transplantation as adoptive immunotherapy for indolent lymphoma: Low incidence of toxicity, acute graft-versus-host disease, and treatment-related mortality

Issa F. Khouri, Rima M. Saliba, Sergio A. Giralt, Ming Sheng Lee, Grace Julia Okoroji, Fredrick B. Hagemeister, Martin Korbling, Anas Younes, Cindy Ippoliti, James L. Gajewski, Peter McLaughlin, Paolo Anderlini, Michele L. Donato, Fernando F. Cabanillas, Richard E. Champlin

Research output: Contribution to journalArticle

317 Citations (Scopus)

Abstract

This study investigated the use of a nonablative conditioning regimen to decrease toxicity and achieve engraftment of an allogeneic blood stem cell transplant, allowing a graft-versus-malignancy effect to occur. All patients had follicular or small cell lymphocytic lymphoma after relapse from a prior response to conventional chemotherapy. Patients received a preparative regimen of fludarabine (25 mg/m2 given daily for 5 days or 30 mg/m2 daily for 3 days) and intravenous cyclophosphamide (1 g/m2 given daily for 2 days or 750 mg/m2 daily for 3 days). Nine patients received rituximab in addition to the chemotherapy. Tacrolimus and methotrexate were used for graft-versus-host disease (GVHD) prophylaxis. Twenty patients were studied; their median age was 51 years. Twelve were in complete remission (CR) at transplantation. All patients achieved engraftment of donor cells. The median number of days with severe neutropenia was 6. Only 2 patients required more than one platelet transfusion. The cumulative incidence of acute grade II to IV GVHD was 20%. Only one patient developed acute GVHD of greater than grade II. All patients achieved CR. None have had a relapse of disease, with a median follow-up period of 21 months. The actuarial probability of being alive and in remission at 2 years was 84% (95% confidence interval, 57%-94%). Nonablative chemotherapy with fludarabine/cyclophosphamide followed by allogeneic stem cell transplantation is a promising therapy for indolent lymphoma with minimal toxicity and myelosuppression. Further studies are warranted to compare nonablative allogeneic hematopoietic transplantation with alternative treatment strategies.

Original languageEnglish (US)
Pages (from-to)3595-3599
Number of pages5
JournalBlood
Volume98
Issue number13
DOIs
StatePublished - Dec 15 2001
Externally publishedYes

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Adoptive Immunotherapy
Homologous Transplantation
Graft vs Host Disease
Grafts
Chemotherapy
Toxicity
Lymphoma
Mortality
Incidence
Stem cells
Cyclophosphamide
Transplants
Tacrolimus
B-Cell Chronic Lymphocytic Leukemia
Therapeutics
Platelets
Methotrexate
Drug Therapy
Blood
Recurrence

ASJC Scopus subject areas

  • Hematology

Cite this

Nonablative allogeneic hematopoietic transplantation as adoptive immunotherapy for indolent lymphoma : Low incidence of toxicity, acute graft-versus-host disease, and treatment-related mortality. / Khouri, Issa F.; Saliba, Rima M.; Giralt, Sergio A.; Lee, Ming Sheng; Okoroji, Grace Julia; Hagemeister, Fredrick B.; Korbling, Martin; Younes, Anas; Ippoliti, Cindy; Gajewski, James L.; McLaughlin, Peter; Anderlini, Paolo; Donato, Michele L.; Cabanillas, Fernando F.; Champlin, Richard E.

In: Blood, Vol. 98, No. 13, 15.12.2001, p. 3595-3599.

Research output: Contribution to journalArticle

Khouri, IF, Saliba, RM, Giralt, SA, Lee, MS, Okoroji, GJ, Hagemeister, FB, Korbling, M, Younes, A, Ippoliti, C, Gajewski, JL, McLaughlin, P, Anderlini, P, Donato, ML, Cabanillas, FF & Champlin, RE 2001, 'Nonablative allogeneic hematopoietic transplantation as adoptive immunotherapy for indolent lymphoma: Low incidence of toxicity, acute graft-versus-host disease, and treatment-related mortality', Blood, vol. 98, no. 13, pp. 3595-3599. https://doi.org/10.1182/blood.V98.13.3595
Khouri, Issa F. ; Saliba, Rima M. ; Giralt, Sergio A. ; Lee, Ming Sheng ; Okoroji, Grace Julia ; Hagemeister, Fredrick B. ; Korbling, Martin ; Younes, Anas ; Ippoliti, Cindy ; Gajewski, James L. ; McLaughlin, Peter ; Anderlini, Paolo ; Donato, Michele L. ; Cabanillas, Fernando F. ; Champlin, Richard E. / Nonablative allogeneic hematopoietic transplantation as adoptive immunotherapy for indolent lymphoma : Low incidence of toxicity, acute graft-versus-host disease, and treatment-related mortality. In: Blood. 2001 ; Vol. 98, No. 13. pp. 3595-3599.
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abstract = "This study investigated the use of a nonablative conditioning regimen to decrease toxicity and achieve engraftment of an allogeneic blood stem cell transplant, allowing a graft-versus-malignancy effect to occur. All patients had follicular or small cell lymphocytic lymphoma after relapse from a prior response to conventional chemotherapy. Patients received a preparative regimen of fludarabine (25 mg/m2 given daily for 5 days or 30 mg/m2 daily for 3 days) and intravenous cyclophosphamide (1 g/m2 given daily for 2 days or 750 mg/m2 daily for 3 days). Nine patients received rituximab in addition to the chemotherapy. Tacrolimus and methotrexate were used for graft-versus-host disease (GVHD) prophylaxis. Twenty patients were studied; their median age was 51 years. Twelve were in complete remission (CR) at transplantation. All patients achieved engraftment of donor cells. The median number of days with severe neutropenia was 6. Only 2 patients required more than one platelet transfusion. The cumulative incidence of acute grade II to IV GVHD was 20{\%}. Only one patient developed acute GVHD of greater than grade II. All patients achieved CR. None have had a relapse of disease, with a median follow-up period of 21 months. The actuarial probability of being alive and in remission at 2 years was 84{\%} (95{\%} confidence interval, 57{\%}-94{\%}). Nonablative chemotherapy with fludarabine/cyclophosphamide followed by allogeneic stem cell transplantation is a promising therapy for indolent lymphoma with minimal toxicity and myelosuppression. Further studies are warranted to compare nonablative allogeneic hematopoietic transplantation with alternative treatment strategies.",
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AU - Khouri, Issa F.

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AU - Giralt, Sergio A.

AU - Lee, Ming Sheng

AU - Okoroji, Grace Julia

AU - Hagemeister, Fredrick B.

AU - Korbling, Martin

AU - Younes, Anas

AU - Ippoliti, Cindy

AU - Gajewski, James L.

AU - McLaughlin, Peter

AU - Anderlini, Paolo

AU - Donato, Michele L.

AU - Cabanillas, Fernando F.

AU - Champlin, Richard E.

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N2 - This study investigated the use of a nonablative conditioning regimen to decrease toxicity and achieve engraftment of an allogeneic blood stem cell transplant, allowing a graft-versus-malignancy effect to occur. All patients had follicular or small cell lymphocytic lymphoma after relapse from a prior response to conventional chemotherapy. Patients received a preparative regimen of fludarabine (25 mg/m2 given daily for 5 days or 30 mg/m2 daily for 3 days) and intravenous cyclophosphamide (1 g/m2 given daily for 2 days or 750 mg/m2 daily for 3 days). Nine patients received rituximab in addition to the chemotherapy. Tacrolimus and methotrexate were used for graft-versus-host disease (GVHD) prophylaxis. Twenty patients were studied; their median age was 51 years. Twelve were in complete remission (CR) at transplantation. All patients achieved engraftment of donor cells. The median number of days with severe neutropenia was 6. Only 2 patients required more than one platelet transfusion. The cumulative incidence of acute grade II to IV GVHD was 20%. Only one patient developed acute GVHD of greater than grade II. All patients achieved CR. None have had a relapse of disease, with a median follow-up period of 21 months. The actuarial probability of being alive and in remission at 2 years was 84% (95% confidence interval, 57%-94%). Nonablative chemotherapy with fludarabine/cyclophosphamide followed by allogeneic stem cell transplantation is a promising therapy for indolent lymphoma with minimal toxicity and myelosuppression. Further studies are warranted to compare nonablative allogeneic hematopoietic transplantation with alternative treatment strategies.

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