Tositumomab/iodine-131 tositumomab (Bexxar) is a novel active agent against
CD20-positive lymphoma. There is a paucity of data examining the tolerance and
outcome of hematopoietic stem cell transplantation (HSCT) for relapse after
From July 1992 to June 2001, 12 patients relapsing after tositumomab/iodine-131
tositumomab underwent HSCT; 2 of these 12 also had a diagnosis of
therapy-related myelodysplasia. There were nine men and three women, with a
median age of 55 years (range: 47-66 years). Patients received a median of 3
(range: 2-6) prior chemotherapy regimens (exclusive of tositumomab/iodine-131
tositumomab) before or after tositumomab/iodine-131 tositumomab. The median
number of chemotherapy regimens was 2 after tositumomab/iodine-131 tositumomab
and prior to HSCT (range: 1-4). The median time from tositumomab/iodine-131
tositumomab therapy to HSCT was 554 days (range: 77-2,893 days). Five patients
had low-grade, four transformed low-grade, and three intermediate-grade
Eight patients received a myeloablative conditioning regimen; four others
received a reduced-intensity regimen consisting of fludarabine (Fludara),
busulfan (Myleran), tacrolimus (Prograf), mycophenolate mofetil (CellCept), and
4 Gy of total lymphoid radiation. Five patients received autologous HSCT: three
marrow and two peripheral blood stem cells. Among seven allogeneic transplants,
three received matched related peripheral blood stem cells and four received
matched unrelated marrow (n = 3) or peripheral blood (n = 1) stem cells.
Allogeneic recipients received tacrolimus and methotrexate for graft-vs-host
disease prophylaxis. Clinical outcome is summarized in the table below:
All patients except two who received reduced intensity had severe mucositis.
Reversible veno-occlusive disease of the liver also developed in two patients.
There was one death from graft-vs-host disease and no regimen-related mortality.
Engraftment was prompt, with a median recovery of absolute neutrophil count to
³ 500/µL of 12 days (range: 11-18 days). Six patients relapsed, including
all five autologous and one allogeneic recipients. Four patients were alive with
no evidence of disease (three matched unrelated donor and one matched related
donor). The other three allogeneic recipients died from either graft-vs-host
disease, relapse, or acetaminophen-induced hepatic necrosis.
CONCLUSION: These data demonstrate the feasibility of allogeneic or
autologous HSCT in heavily pretreated lymphoma patients who also received