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Allografting

Reduced-intensity allogeneic hematopoietic cell transplantation using fludarabine–melphalan conditioning for treatment of mature T-cell lymphomas

Bone Marrow Transplantation volume 47, pages 65–72 (2012)Cite this article

Abstract

Among non-Hodgkin's lymphoma subtypes, T-cell phenotype confers a poor clinical prognosis. For more aggressive histologies, patients frequently present with advanced disease that is inherently chemoresistant. For cutaneous histologies, disease progresses less rapidly, but is debilitating and often incurable in the long term. Here we report the retrospective analysis of data from 27 patients with mature T-cell lymphoma treated with salvage allogeneic haematopoietic cell transplantation at the City of Hope, Duarte, CA, USA, using a reduced-intensity fludarabine/melphalan conditioning regimen between the years 2001 and 2008. Eleven of the twenty-seven patients had cutaneous T-cell lymphoma (CTCL). The majority of patients had advanced disease at the time of transplant (17/27 or 63%). Median follow-up was 36 months. We observed a 2-year OS of 55%, a PFS of 47% and a cumulative incidence of relapse/progression and non-relapse mortality (NRM) of 30 and 22%, respectively. For CTCL, patients had a 2-year PFS of 45% and NRM of 27% compared with patients with other histologies, who had a PFS of 62% and NRM of 19%. Overall, our results suggest that meaningful long-term survival rates and disease control can be achieved with acceptable non-relapse mortality in patients with mature T-cell lymphomas, including CTCL using reduced-intensity conditioning with melphalan and fludarabine.

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Acknowledgements

This study was supported in part by grants from the National Institute of Health, CA30206 and CA33572 and CA107399. We acknowledge the dedicated nurses of the City of Hope Bone Marrow Unit for excellent care of our patients and support of medical research.

Twenty-two of the patients on this study are also included in a larger analysis of allogeneic transplant for NHL performed at the City of Hope, which is currently under review at another journal. Our manuscript focuses specifically on reduced-intensity results for T-cell NHL, with a focus on CTCL, and gives a more thorough analysis, a comprehensive patient list, as well as including additional patients acquired after the close of analysis of the larger study.

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Authors and Affiliations

  1. Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA

    M Delioukina, S Thomas & S Forman

  2. NYU Langone Medical Center, New York, NY, USA

    J Zain

  3. Department of Information Sciences, City of Hope, Duarte, CA, USA

    J M Palmer & N Tsai

Authors
  1. M Delioukina
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  2. J Zain
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  5. S Thomas
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Correspondence to M Delioukina.

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Delioukina, M., Zain, J., Palmer, J. et al. Reduced-intensity allogeneic hematopoietic cell transplantation using fludarabine–melphalan conditioning for treatment of mature T-cell lymphomas. Bone Marrow Transplant 47, 65–72 (2012). https://doi.org/10.1038/bmt.2011.16

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