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Long-term graft-versus-Waldenström macroglobulinemia effect following reduced intensity conditioning allogeneic stem cell transplantation

Bone Marrow Transplantation volume 40, pages 175–177 (2007)Cite this article

Waldenström's macroglobulinemia (WM) is a rare B cell lymphoproliferative disorder of the elderly. In symptomatic WM, recent guidelines recommend the use of rituximab and nucleoside analogues (fludarabine) with or without alkylating agents as front-line treatment.1 However, such therapies can only achieve complete remission (CR) rates ranging from 10 to 40%.2 The use of high-dose chemotherapy and autologous stem cell transplantation (SCT) may lead to interesting results.3, 4, 5 However, most patients will ultimately relapse, highlighting the need for novel therapeutic approaches, especially in younger patients or those with very aggressive disease. We report here the long-term follow-up of a WM patient successfully treated with reduced intensity conditioning (RIC) allogeneic SCT (allo-SCT).

WM is probably an incurable lymphoid malignancy with a median survival of 87 months.6 Allo-SCT is not a classical indication for WM and only few cases have been reported thus far (Table 1). However, an immune graft-versus-tumor (GVT) effect was already suggested after conventional allo-SCT. Although it remains difficult in the standard allo-SCT setting to determine the relative contribution of the myeloablative conditioning and the allogeneic effect, GVT effect was suggested since responding patients experienced simultaneous chronic GVHD and were still in CR several years after allo-SCT.3, 7, 8 Unfortunately, among 13 myeloablative allo-SCT cases reviewed here, six (46%) died of early transplant-related mortality (TRM). Since the median age at diagnosis of WM is around 67 years and because of this high risk of TRM, a RIC regimen is probably a more valid option. Among the previously published cases of RIC allo-SCT for WM, and due to short follow-up, a genuine GVT effect and long-term sustained CR could not be documented. The current case has a relatively long-term follow-up of more than 2 years. Moreover, a potent GVT effect was induced with relatively little toxicity, since allo-SCT was performed with evidence of high disease burden (IgM=16 g/dl), and CR was achieved concomitantly to GVHD onset. Obviously, one could discuss the role of fludarabine contained within the RIC regimen in disease response. However, such hypothesis is likely to be untrue because the patient was previously only partially responder to a second-line fludarabine-based chemotherapy. In all, this case suggests that RIC allo-SCT is a potentially curative option for WM refractory to standard chemotherapy. Given the relatively low incidence of TRM associated with the use of nonmyeloablative and less toxic preparative regimens and based on the recently proposed ‘lymphoma like’ prognostic index for WM,6, 9 we conclude that if an HLA-matched sibling is identified, RIC allo-SCT should be considered even in elderly or heavily pretreated patients.

Table 1 Reported cases of patients with WM who underwent allo-SCT
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References

  1. Treon SP, Gertz MA, Dimopoulos M, Anagnostopoulos A, Blade J, Branagan AR et al. Update on treatment recommendations from the Third International Workshop on Waldenstrom's macroglobulinemia. Blood 2006; 107: 3442–3446.

    Article  CAS  Google Scholar 

  2. Treon SP, Hunter Z, Barnagan AR . CHOP plus rituximab therapy in Waldenstrom's macroglobulinemia. Clin Lymphoma 2005; 5: 273–277.

    Article  CAS  Google Scholar 

  3. Tournilhac O, Leblond V, Tabrizi R, Gressin R, Senecal D, Milpied N et al. Transplantation in Waldenstrom's macroglobulinemia – the French experience. Semin Oncol 2003; 30: 291–296.

    Article  CAS  Google Scholar 

  4. Anagnostopoulos A, Dimopoulos MA, Aleman A, Weber D, Alexanian R, Champlin R et al. High-dose chemotherapy followed by stem cell transplantation in patients with resistant Waldenstrom's macroglobulinemia. Bone Marrow Transplant 2001; 27: 1027–1029.

    Article  CAS  Google Scholar 

  5. Anagnostopoulos A, Hari PN, Perez WS, Ballen K, Bashey A, Bredeson CN et al. Autologous or allogeneic stem cell transplantation in patients with Waldenstrom's macroglobulinemia. Biol Blood Marrow Transplant 2006; 12: 845–854.

    Article  Google Scholar 

  6. Levy V, Morel P, Porcher R, Chevret S, Wattel E, Leblond V . Advanced Waldenstrom's macroglobulinemia: usefulness of Morel's scoring system in establishing prognosis. Haematologica 2005; 90: 279–281.

    PubMed  Google Scholar 

  7. Ueda T, Hatanaka K, Kosugi S, Kishino BI, Tamaki T . Successful non-myeloablative allogeneic peripheral blood stem cell transplantation (PBSCT) for Waldenstrom's macroglobulinemia with severe pancytopenia. Bone Marrow Transplant 2001; 28: 609–611.

    Article  CAS  Google Scholar 

  8. Martino R, Shah A, Romero P, Brunet S, Sierra J, Domingo-Albos A et al. Allogeneic bone marrow transplantation for advanced Waldenstrom's macroglobulinemia. Bone Marrow Transplant 1999; 23: 747–749.

    Article  CAS  Google Scholar 

  9. Ghobrial IM, Fonseca R, Gertz MA, Plevak MF, Larson DR, Therneau TM et al. Prognostic model for disease-specific and overall mortality in newly diagnosed symptomatic patients with Waldenstrom's macroglobulinaemia. Br J Haematol 2006; 133: 158–164.

    Article  Google Scholar 

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Authors and Affiliations

  1. Unité de Transplantation et de Thérapie Cellulaire, Institut Paoli-Calmettes, Marseille, France

    J-C Meniane, J El-Cheikh, C Faucher, S Fürst, D Blaise & M Mohty

  2. Département d'Hématologie, Institut Paoli-Calmettes, Marseille, France

    R Bouabdallah

  3. Université de la Méditerranée, Marseille, France

    D Blaise & M Mohty

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  1. J-C Meniane
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Correspondence to M Mohty.

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Meniane, JC., El-Cheikh, J., Faucher, C. et al. Long-term graft-versus-Waldenström macroglobulinemia effect following reduced intensity conditioning allogeneic stem cell transplantation. Bone Marrow Transplant 40, 175–177 (2007). https://doi.org/10.1038/sj.bmt.1705702

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