Abstract
To test the value of non-TBI based reduced intensity stem cell transplantation (RIST) in high risk patients with NHL, CLL and MM, 52 patients were transplanted using fludarabin 25 mg/m2 and cyclophosphamide 500 mg/m2, for 5 days and an undepleted HLA-identical sibling allograft.
Patients: diagnosis: indolent NHL (10), diffuse large cell lymphoma (8), mantle cell lymphoma (2), multiple myeloma (17), CLL (10), other diagnosis (5).
Patient characteristics: 34M/18F, median age 52.9 yr (range 18–66 yr). All patients were extensively pre-treated. None of CLL patients had received an autologous transplant, but of all remaining patients 71% had been autografted previously. Best response in NHL patients at transplant: CR in 2; PR in 16; PD in 2. The graft consisted of 6.8 × 106/kg CD34+ cells (median, range: 2.7 – 20) and T-cells 34.1 × 107/kg (range 14.5–66).
Results: Hematological recovery: nadirs respectively: WBC: 0.34 × 109/l (median, range <0.1 – 1.6) at day +4, platelets: 38 × 109/l (2–130) at day 8, ANC: 0.09 (0 – 0.36). Toxicity was minimal: mucositis > grade I: 4 patients; TPN: 7 patients; antibiotics i.v.: 8 patients; hemorrhagic cystitis: 2.
Engraftment was prompt in all but one patient. Chimerism measured by short tandem repeats (STR) at day +30, +100 and +180 were 85%, 95% and 95% respectively (median, range 15 – 100%). Acute GVHD grade I/II was seen in 10 (19%) and grade III/IV in 11 (21%). Chronic GVHD occurred in 12 patients (limited 5 (10%), extensive 7 (13%). Transplant related mortality was only 10%. With a median follow-up of 48 months for NHL patients the estimated survival is 78%. For CLL and MM patients follow-up is still to short for conclusions, but survival seems inferior in MM patients
Conclusion: fludarabin/cyclophosphamide allogeneic transplantation provides an excellent rescue treatment for heavily pretreated lymphoma patients.
Survival Flu/Cy allogeneic RIST transplantation
Disclosure: No relevant conflicts of interest to declare.
