1. ¹Hematology, Department of Medicine, University Hospital Basel, Basel, Switzerland
2. ²Department of Immunohematology and Bloodtransfusion, Leiden University Medial Center, Leiden, The Netherlands
3. ³Department of Experimental Hematology and Clinical Immunology, Perugia University Hospital, Perugia, Italy
4. ⁴Oncology, Medical University Clinic, Kantonsspital, Liestal, Switzerland
5. ⁵Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
6. ⁶Hematology Service, Department of Internal Medicine, University Hospital, Geneva, Switzerland

Correspondence: Dr AS Buser, Hematology, Department of Medicine, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland. E-mail: busera@uhbs.ch

⁷Current address (until 21 March 2007): Department of Immunohematology and Bloodtransfusion, Leiden University Medical Center, Albinusdreef 2, 2300RC Leiden, The Netherlands.

⁸These authors contributed equally to this work.

Received 2 October 2006; Revised 12 December 2006; Accepted 31 December 2006.

Abstract

Patients with refractory/relapsing lymphoma are rarely cured by chemotherapy. High-dose chemotherapy (HDC) for tumor debulking followed by reduced-intensity conditioning (RIC) hematopoietic stem-cell transplantation (HSCT) has been advocated as a concept. We previously treated 10 patients (group A) with BEAM chemotherapy followed by delayed RIC HSCT at day 28. We now report on the subsequent 11 patients receiving BEAM followed immediately by fludarabine/total body irradiation and allogeneic HSCT (group B), and compare the outcome to group A patients. Non-hematological toxicity before engraftment was comparable, only gut toxicity was higher in group B. Days in aplasia, days on antibiotics and length of hospital stay were significantly longer in group A. Cumulative incidence of acute (GvHD) grade II and incidence of chronic GvHD were lower in group B. At last follow-up, seven patients in group A were alive, with six of them in complete remission. In group B, nine patients were alive, seven of them in complete remission. No significant difference in estimated 3-year overall survival was seen. These data challenge the initial concept of debulking first and delaying allogeneic RIC HSCT. Allogeneic HSCT with standard BEAM conditioning is a valid alternative for patients with resistant/relapsed lymphoma, which might be considered earlier in the disease course.