T-Cell–Depleted Allogeneic Bone Marrow Transplant From HLA-Matched Sibling Donors for Non-Hodgkin’s Lymphoma

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Article
OncologyONCOLOGY Vol 13 No 3
Volume 13
Issue 3

The role of allogeneic bone marrow transplant (BMT) as a treatment for advanced non-Hodgkin’s lymphoma (NHL) has not been established. Historical limitations tothis approach have included the relatively advanced age of these patients, as well as their extensive treatment prior to BMT. Accordingly, only limited data have been reported about overall and/or disease-free survival in these patients. Depletion of T-cells offers the potential for older patients to undergo allogeneic BMT by reducing complications related to graft-vs-host disease (GVHD), but whether the graft-vs-lymphoma effect would be correspondingly reduced is unknown.

The role of allogeneic bone marrow transplant (BMT) as a treatment for advanced non-Hodgkin’s lymphoma (NHL) has not been established. Historical limitations tothis approach have included the relatively advanced age of these patients, as well as their extensive treatment prior to BMT. Accordingly, only limited data have been reported about overall and/or disease-free survival in these patients. Depletion of T-cells offers the potential for older patients to undergo allogeneic BMT by reducing complications related to graft-vs-host disease (GVHD), but whether the graft-vs-lymphoma effect would be correspondingly reduced is unknown.

We report an analysis of 24 consecutive patients with NHL who underwent T-cell–depleted allogeneic BMT at Memorial Hospital from April 1992 through November 1997. There were 13 males and 11 females. The median age at the time of BMT was 41 years (range, 5-59 years). Histologic subtypes included intermediate-grade lymphoma in 11 patients, low-grade lymphoma in 6, mantle cell lymphoma in 4, and lymphoblastic lymphoma in 3. All patients received allografts in lieu of autografts based on the presence of an available HLA-identical sibling donor and the lack of chemosensitive disease and/or marrow involvement. All patients had been extensively pretreated, receiving 2or more prior courses of chemotherapy. Pretransplant cytoreduction consisted of hyperfractionated total-body irradiation (1,500 cGy), thiotepa (10 mg/kg), and cyclophosphamide (Cytoxan, Neosar; 120 mg/kg). Allografts were depleted of T-cells by soybean lectin agglutination and sheep red blood cell rosetting.

Ten patients died within the first 100 days of BMT, including six from infection and two from residual disease. One patient developed grade 4 acute GVHD; this patient remains alive and without evidence of chronic GVHD 10 months following BMT. None of the other evaluable patients developed acute or chronic GVHD.

At a median follow-up of 25 months, the product-limit estimates of overall and disease-free survival were 0.58 and 0.43, respectively. Of 14 patients who were long-term survivors, 3 showed evidence of relapsed disease and were reinduced into remission with chemotherapy and/or radiotherapy followed by adoptive immunotherapy.

CONCLUSION: We conclude that T-cell–depleted allogeneic BMT offers the potential for extended disease-free survival, and even outright cure, in patients with advanced NHL who are not candidates for autologous transplantation. The graft-vs-lymphoma effect of T-cell–depleted allografts appears to be retained in the absence of significant GVHD. Results may be further improved by earlier transplantation, modification of cytoreduction, or the use of adoptive immunotherapy.

 Click here for Dr. Bruce Cheson’s commentary on this abstract.

Articles in this issue

WHO Declares Lymphatic Mapping to Be the Standard of Care for Melanoma
Rituximab: Phase II Retreatment Study in Patients With Low-Grade or Follicular Non-Hodgkin’s Lymphoma
Response Criteria for NHL: Importance of “Normal” Lymph Node Size and Correlations With Response
Chemotherapy Plus Radiation Improves Survival in Patients With Cervical Cancer
A Randomized Trial of Fludarabine, Mitoxantrone (FM) Versus Doxorubicin, Cyclophosphamide, Vindesine, Prednisone (CHEP) as First Line Treatment in Patients With Advanced Low-Grade Non-Hodgkin's Lymphoma: A Multicenter Study by GOELAMS Group
Navelbine Increased Elderly Lung Cancer Patients’ Survival
Fludarabine Versus Conventional CVP Chemotherapy in Newly C Diagnosed Patients With Stages III and IV Low-Grade Malignant Non-Hodgkin’s Lymphoma: Preliminary Results From a Prospective, Randomized Phase III Clinical Trial in 381 Patients
Multicenter, Phase III Study of Iodine-131 Tositumomab (Anti-B1 Antibody) for Chemotherapy-Refractory Low-Grade or Transformed Low-Grade Non-Hodgkin’s Lymphoma
T-Cell–Depleted Allogeneic Bone Marrow Transplant From HLA-Matched Sibling Donors for Non-Hodgkin’s Lymphoma
Consensus Statement on Prevention and Early Diagnosis of Lung Cancer
In Vivo Purging and Adjuvant Immunotherapy With Rituximab During PBSC Transplant For NHL
Fludarabine and Cyclophosphamide: A Highly Active and Well-Tolerated Regimen for Patients With Previously Untreated Indolent Lymphomas
Campath-1H Monoclonal Antibody in Therapy for Advanced Low-Grade Non-Hodgkin’s Lymphomas: A Phase II Study
AIDS Drugs Effective Against Most Common HIV Strain
Rituximab Therapy in Previously Treated Waldenström’s Macroglobulinemia: Preliminary Evidence of Activity
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