Abstract
Non-myeloablative regimens have been proven to allow engraftment following allogeneic stem cells transplantation (allo-SCT) with minimal procedure-related toxicity. Conventional allo-SCT may produce remissions in patients with relapsed and refractory lymphoid malignancies (LM) but these good results may be achieved at the cost of high treatment-related morbidity and mortality. Application of allo-SCT using less intensive regimens may temper the frequency of these complications, allowing a potent graft-versus-tumor effect (GVT). We present our data on 11 patients with LM receiving allo-SCT with a reduced regimen. Ten patients had received previous high-dose therapy, and were at high risk for toxicity, thus precluding the use of allo-SCT. A fludarabine and low-dose busulfan combination facilitated engraftment while exerting GVT. Hematological recovery was quick, and full donor T cell chimerism preceded acute GVHD. GVHD and infections were the major problems. Spontaneous acute GVHD occurred in eight patients (72%). Five patients (45%) achieved complete remission, and the GVT effect was closely associated with GVHD. These results support the concept that GVT is effective against LM in patients who have been heavily pretreated. Further studies are needed to investigate strategies to generate more specific alloreactive effects providing optimal GVT and an acceptable risk of GVHD and infections. Bone Marrow Transplantation (2001) 28, 335–339.
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References
Horowitz MM, Gale RP, Sondel PM et al. Graft-versus-leukemia reactions after bone marrow transplantation Blood 1990 75: 555–562
Ben-Yosef R, Or R, Nagler A, Slavin S . Graft-versus-tumour and graft-versus-leukaemia effect in patient with concurrent breast cancer and acute myelocytic leukaemia Lancet 1996 348: 1242–1243
Slavin S, Nagler A, Naparstek E et al. Nonmyeloablative stem cell transplantation and cell therapy as an alternative to conventional bone marrow transplantation with lethal cytoreduction for the treatment of malignant and nonmalignant hematologic diseases Blood 1998 91: 756–763
Goldman JM, Gale RP, Horowitz MM et al. Bone marrow transplantation for chronic myelogenous leukemia in chronic phase. Increased risk for relapse associated with T-cell depletion Ann Intern Med 1988 108: 806–814
Gale RP, Horowitz MM, Ash RC et al. Identical-twin bone marrow transplants for leukemia Ann Intern Med 1994 120: 646–652
Kolb HJ, Schattenberg A, Goldman JM et al. Graft-versus-leukemia effect of donor lymphocyte transfusions in marrow grafted patients. European Group for Blood and Marrow Transplantation Working Party Chronic Leukemia Blood 1995 86: 2041–2050
Attal M, Harousseau JL, Stoppa AM et al. A prospective, randomized trial of autologous bone marrow transplantation and chemotherapy in multiple myeloma New Engl J Med 1996 335: 91–97
Bensinger WI . Hematopoietic cell transplantation for multiple myeloma Cancer Control 1998 5: 235–242
Waselenko JK, Flynn JM, Byrd JC . Stem-cell transplantation in chronic lymphocytic leukemia: the time for designing randomized studies has arrived Semin Oncol 1999 26: 48–61
Blaise D, Kuentz M, Fortanier C et al. Randomized trial of bone marrow versus lenograstim-primed blood cell allogeneic transplantation in patients with early-stage leukemia: a report from the Societe Francaise de Greffe de Moelle J Clin Oncol 2000 18: 537–546
Bensinger WI, Martin PJ, Storer B et al. Transplantation of bone marrow as compared with peripheral-blood cells from HLA-identical relatives in patients with hematologic cancers New Engl J Med 2001 344: 175–181
van Besien KW, Mehra RC, Giralt SA et al. Allogeneic bone marrow transplantation for poor-prognosis lymphoma: response, toxicity and survival depend on disease histology Am J Med 1996 100: 299–307
van Bekkum DW . Conditioning regimens for marrow grafting Semin Hematol 1984 21: 81–90
Boeckh M, Bowden RA, Goodrich JM et al. Cytomegalovirus antigen detection in peripheral blood leukocytes after allogeneic marrow transplantation Blood 1992 80: 1358–1364
Bacigalupo A, Tedone E, Isaza A et al. CMV-antigenemia after allogeneic bone marrow transplantation: correlation of CMV-antigen positive cell numbers with transplant-related mortality Bone Marrow Transplant 1995 16: 155–161
Mohty M, Faucher C, Vey N et al. High rate of secondary viral and bacterial infections in patients undergoing allogeneic bone marrow mini-transplantation Bone Marrow Transplant 2000 26: 251–255
Vogelsang GB . Advances in the treatment of graft-versus-host disease Leukemia 2000 14: 509–510
Slavin S, Naparstek E, Nagler A et al. Allogeneic cell therapy with donor peripheral blood cells and recombinant human interleukin-2 to treat leukemia relapse after allogeneic bone marrow transplantation Blood 1996 87: 2195–2204
Tricot G, Vesole DH, Jagannath S et al. Graft-versus-myeloma effect: proof of principle Blood 1996 87: 1196–1198
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Mohty, M., Fegueux, N., Exbrayat, C. et al. Enhanced graft-versus-tumor effect following dose-reduced conditioning and allogeneic transplantation for refractory lymphoid malignancies after high-dose therapy. Bone Marrow Transplant 28, 335–339 (2001). https://doi.org/10.1038/sj.bmt.1703134
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DOI: https://doi.org/10.1038/sj.bmt.1703134
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