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Allografting

High-dose chemotherapy using BEAM without autologous rescue followed by reduced-intensity conditioning allogeneic stem-cell transplantation for refractory or relapsing lymphomas: a comparison of delayed versus immediate transplantation

Bone Marrow Transplantation volume 39, pages 335–340 (2007)Cite this article

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.

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Acknowledgements

ASB is supported by research grants from the Novartis Stiftung and the Swiss National Science Foundation (Grant PBBSB-108506). This work is supported by research grants from the Swiss Cancer League (Grant BIL OCS 01597-08-2004) and the Swiss National Science Foundation (Grant PBBSB-107328). The study was supported by the Swiss National Research Foundation (Grant 3200B0-106105). We thank Lothar Hambach for valuable discussions and critically reviewing the paper.

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Author notes

  1. A S Buser

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

  2. A S Buser and M Stern: These authors contributed equally to this work.

Authors and Affiliations

  1. Department of Medicine, Hematology, University Hospital Basel, Basel, Switzerland

    A S Buser, M Stern, C Bucher, C Arber, D Heim, J Halter, S Meyer-Monard, G Stussi, A Tichelli & A Gratwohl

  2. Department of Immunohematology and Bloodtransfusion, Leiden University Medial Center, Leiden, The Netherlands

    A S Buser

  3. Department of Experimental Hematology and Clinical Immunology, Perugia University Hospital, Perugia, Italy

    M Stern

  4. Oncology, Medical University Clinic, Kantonsspital, Liestal, Switzerland

    A Lohri

  5. Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland

    M Ghielmini

  6. Department of Internal Medicine, Hematology Service, University Hospital, Geneva, Switzerland

    J R Passweg

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  1. A S Buser
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Correspondence to A S Buser.

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Buser, A., Stern, M., Bucher, C. et al. High-dose chemotherapy using BEAM without autologous rescue followed by reduced-intensity conditioning allogeneic stem-cell transplantation for refractory or relapsing lymphomas: a comparison of delayed versus immediate transplantation. Bone Marrow Transplant 39, 335–340 (2007). https://doi.org/10.1038/sj.bmt.1705597

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  • DOI: https://doi.org/10.1038/sj.bmt.1705597

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