Nonmyeloablative allogeneic hematopoietic cell transplantation in relapsed, refractory, and transformed indolent non-Hodgkin's lymphoma

Andrew R. Rezvani, Barry Storer, Michael Maris, Mohamed L. Sorror, Edward Agura, Richard Maziarz, James C. Wade, Thomas Chauncey, Stephen J. Forman, Thoralf Lange, Judith Shizuru, Amelia Langston, Michael A. Pulsipher, Brenda M. Sandmaier, Rainer Storb, David G. Maloney

Research output: Contribution to journalArticle

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Abstract

Purpose: Few effective treatment options exist for chemotherapy-refractory indolent or transformed non-Hodgkin's lymphoma (NHL). We examined the outcome of nonmyeloablative allogeneic hematopoietic cell transplantation (HCT) in this setting. Patients and Methods: Sixty-two patients with indolent or transformed NHL were treated with allogeneic HCT from related (n = 34) or unrelated (n = 28) donors after conditioning with 2 Gy of total-body irradiation with or without fludarabine. Nine unrelated donors were mismatched for ≥ one HLA antigen. Sixteen patients had histologic transformation before HCT. Twenty patients (32%) had progressive disease after previous high-dose therapy with autologous HCT. Median age was 54 years, and patients had received a median of six lines of treatment before HCT. Median follow-up time after HCT was 36.6 months. Results: At 3 years, the estimated overall survival (OS) and progression-free survival (PFS) rates were 52% and 43%, respectively, for patients with indolent disease, and 18% and 21%, respectively, for patients with transformed disease. Patients with indolent disease and related donors (n = 26) had 3-year estimated OS and PFS rates of 67% and 54%, respectively. The incidences of grade 2 to 4 acute graft-versus-host disease (GVHD), grade 3 and 4 acute GVHD, and extensive chronic GVHD were 63%, 18%, and 47%, respectively. Among survivors, the median Karnofsky performance status at last follow-up was 85%. Conclusion: Nonmyeloablative allogeneic HCT can produce durable disease-free survival in patients with relapsed or refractory indolent NHL, even in this relatively elderly and heavily pretreated cohort. Outcomes were particularly good in patients with untransformed disease and related donors, whereas patients with transformed disease did poorly. Long-term survivors reported good overall functional status.

Original languageEnglish (US)
Pages (from-to)211-217
Number of pages7
JournalJournal of Clinical Oncology
Volume26
Issue number2
DOIs
StatePublished - Jan 10 2008
Externally publishedYes

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Cell Transplantation
Non-Hodgkin's Lymphoma
Graft vs Host Disease
Disease-Free Survival
Tissue Donors
Survivors
Survival Rate
Karnofsky Performance Status
Unrelated Donors
Survival
Whole-Body Irradiation
HLA Antigens
Therapeutics
Drug Therapy

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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Nonmyeloablative allogeneic hematopoietic cell transplantation in relapsed, refractory, and transformed indolent non-Hodgkin's lymphoma. / Rezvani, Andrew R.; Storer, Barry; Maris, Michael; Sorror, Mohamed L.; Agura, Edward; Maziarz, Richard; Wade, James C.; Chauncey, Thomas; Forman, Stephen J.; Lange, Thoralf; Shizuru, Judith; Langston, Amelia; Pulsipher, Michael A.; Sandmaier, Brenda M.; Storb, Rainer; Maloney, David G.

In: Journal of Clinical Oncology, Vol. 26, No. 2, 10.01.2008, p. 211-217.

Research output: Contribution to journalArticle

Rezvani, AR, Storer, B, Maris, M, Sorror, ML, Agura, E, Maziarz, R, Wade, JC, Chauncey, T, Forman, SJ, Lange, T, Shizuru, J, Langston, A, Pulsipher, MA, Sandmaier, BM, Storb, R & Maloney, DG 2008, 'Nonmyeloablative allogeneic hematopoietic cell transplantation in relapsed, refractory, and transformed indolent non-Hodgkin's lymphoma', Journal of Clinical Oncology, vol. 26, no. 2, pp. 211-217. https://doi.org/10.1200/JCO.2007.11.5477
Rezvani, Andrew R. ; Storer, Barry ; Maris, Michael ; Sorror, Mohamed L. ; Agura, Edward ; Maziarz, Richard ; Wade, James C. ; Chauncey, Thomas ; Forman, Stephen J. ; Lange, Thoralf ; Shizuru, Judith ; Langston, Amelia ; Pulsipher, Michael A. ; Sandmaier, Brenda M. ; Storb, Rainer ; Maloney, David G. / Nonmyeloablative allogeneic hematopoietic cell transplantation in relapsed, refractory, and transformed indolent non-Hodgkin's lymphoma. In: Journal of Clinical Oncology. 2008 ; Vol. 26, No. 2. pp. 211-217.
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abstract = "Purpose: Few effective treatment options exist for chemotherapy-refractory indolent or transformed non-Hodgkin's lymphoma (NHL). We examined the outcome of nonmyeloablative allogeneic hematopoietic cell transplantation (HCT) in this setting. Patients and Methods: Sixty-two patients with indolent or transformed NHL were treated with allogeneic HCT from related (n = 34) or unrelated (n = 28) donors after conditioning with 2 Gy of total-body irradiation with or without fludarabine. Nine unrelated donors were mismatched for ≥ one HLA antigen. Sixteen patients had histologic transformation before HCT. Twenty patients (32{\%}) had progressive disease after previous high-dose therapy with autologous HCT. Median age was 54 years, and patients had received a median of six lines of treatment before HCT. Median follow-up time after HCT was 36.6 months. Results: At 3 years, the estimated overall survival (OS) and progression-free survival (PFS) rates were 52{\%} and 43{\%}, respectively, for patients with indolent disease, and 18{\%} and 21{\%}, respectively, for patients with transformed disease. Patients with indolent disease and related donors (n = 26) had 3-year estimated OS and PFS rates of 67{\%} and 54{\%}, respectively. The incidences of grade 2 to 4 acute graft-versus-host disease (GVHD), grade 3 and 4 acute GVHD, and extensive chronic GVHD were 63{\%}, 18{\%}, and 47{\%}, respectively. Among survivors, the median Karnofsky performance status at last follow-up was 85{\%}. Conclusion: Nonmyeloablative allogeneic HCT can produce durable disease-free survival in patients with relapsed or refractory indolent NHL, even in this relatively elderly and heavily pretreated cohort. Outcomes were particularly good in patients with untransformed disease and related donors, whereas patients with transformed disease did poorly. Long-term survivors reported good overall functional status.",
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T1 - Nonmyeloablative allogeneic hematopoietic cell transplantation in relapsed, refractory, and transformed indolent non-Hodgkin's lymphoma

AU - Rezvani, Andrew R.

AU - Storer, Barry

AU - Maris, Michael

AU - Sorror, Mohamed L.

AU - Agura, Edward

AU - Maziarz, Richard

AU - Wade, James C.

AU - Chauncey, Thomas

AU - Forman, Stephen J.

AU - Lange, Thoralf

AU - Shizuru, Judith

AU - Langston, Amelia

AU - Pulsipher, Michael A.

AU - Sandmaier, Brenda M.

AU - Storb, Rainer

AU - Maloney, David G.

PY - 2008/1/10

Y1 - 2008/1/10

N2 - Purpose: Few effective treatment options exist for chemotherapy-refractory indolent or transformed non-Hodgkin's lymphoma (NHL). We examined the outcome of nonmyeloablative allogeneic hematopoietic cell transplantation (HCT) in this setting. Patients and Methods: Sixty-two patients with indolent or transformed NHL were treated with allogeneic HCT from related (n = 34) or unrelated (n = 28) donors after conditioning with 2 Gy of total-body irradiation with or without fludarabine. Nine unrelated donors were mismatched for ≥ one HLA antigen. Sixteen patients had histologic transformation before HCT. Twenty patients (32%) had progressive disease after previous high-dose therapy with autologous HCT. Median age was 54 years, and patients had received a median of six lines of treatment before HCT. Median follow-up time after HCT was 36.6 months. Results: At 3 years, the estimated overall survival (OS) and progression-free survival (PFS) rates were 52% and 43%, respectively, for patients with indolent disease, and 18% and 21%, respectively, for patients with transformed disease. Patients with indolent disease and related donors (n = 26) had 3-year estimated OS and PFS rates of 67% and 54%, respectively. The incidences of grade 2 to 4 acute graft-versus-host disease (GVHD), grade 3 and 4 acute GVHD, and extensive chronic GVHD were 63%, 18%, and 47%, respectively. Among survivors, the median Karnofsky performance status at last follow-up was 85%. Conclusion: Nonmyeloablative allogeneic HCT can produce durable disease-free survival in patients with relapsed or refractory indolent NHL, even in this relatively elderly and heavily pretreated cohort. Outcomes were particularly good in patients with untransformed disease and related donors, whereas patients with transformed disease did poorly. Long-term survivors reported good overall functional status.

AB - Purpose: Few effective treatment options exist for chemotherapy-refractory indolent or transformed non-Hodgkin's lymphoma (NHL). We examined the outcome of nonmyeloablative allogeneic hematopoietic cell transplantation (HCT) in this setting. Patients and Methods: Sixty-two patients with indolent or transformed NHL were treated with allogeneic HCT from related (n = 34) or unrelated (n = 28) donors after conditioning with 2 Gy of total-body irradiation with or without fludarabine. Nine unrelated donors were mismatched for ≥ one HLA antigen. Sixteen patients had histologic transformation before HCT. Twenty patients (32%) had progressive disease after previous high-dose therapy with autologous HCT. Median age was 54 years, and patients had received a median of six lines of treatment before HCT. Median follow-up time after HCT was 36.6 months. Results: At 3 years, the estimated overall survival (OS) and progression-free survival (PFS) rates were 52% and 43%, respectively, for patients with indolent disease, and 18% and 21%, respectively, for patients with transformed disease. Patients with indolent disease and related donors (n = 26) had 3-year estimated OS and PFS rates of 67% and 54%, respectively. The incidences of grade 2 to 4 acute graft-versus-host disease (GVHD), grade 3 and 4 acute GVHD, and extensive chronic GVHD were 63%, 18%, and 47%, respectively. Among survivors, the median Karnofsky performance status at last follow-up was 85%. Conclusion: Nonmyeloablative allogeneic HCT can produce durable disease-free survival in patients with relapsed or refractory indolent NHL, even in this relatively elderly and heavily pretreated cohort. Outcomes were particularly good in patients with untransformed disease and related donors, whereas patients with transformed disease did poorly. Long-term survivors reported good overall functional status.

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DO - 10.1200/JCO.2007.11.5477

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