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Conditioning Regimens

Allogeneic transplantation after reduced-intensity conditioning with fludarabine–CY for both indolent and aggressive lymphoid malignancies

Bone Marrow Transplantation volume 49, pages 513–518 (2014)Cite this article

Abstract

We studied the outcome of allo-SCT after reduced-intensity conditioning in relapsed or refractory indolent and aggressive lymphoid malignancies. All 54 patients (diagnosis: B-CLL n=13, indolent lymphoma n=12, aggressive lymphoma n=13, transformed lymphoma n=16) received conditioning with fludarabine and CY between July 2001 and November 2010. They underwent allo-SCT because of relapse after auto-SCT or because no other therapy could lead to a meaningful remission. Patients received an unmanipulated peripheral blood stem-cell graft. Median follow-up was 67 months. Thirty-two patients had received rituximab. Immediately after transplantation, remission status had improved in 21 patients, all without DLI. During the follow-up six additional patients achieved CR without further therapy. Four-year OS (EFS) was 46% (46%) for B-CLL, 83% (75%) for indolent lymphoma, 69% (55%) for aggressive lymphoma and 74% (67%) for transformed lymphoma (P=0.28 (P=0.54)). Forty two percent developed acute GVHD, 68% chronic GVHD (16% limited, 52% extensive). Previous auto-SCT did not influence OS, while acute GVHD did. Two-year non-relapse mortality was 16%. In conclusion, reduced-intensity conditioning with fludarabine–CY is feasible and effective for both indolent and aggressive lymphoid malignancies, even after previous auto-SCT. Because of the excellent anti-B-cell/lymphoma activity fludarabine–CY decreases tumor load, gaining time for the development of a graft versus lymphoma effect.

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Authors and Affiliations

  1. Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands

    M J Wondergem, F S Dijkstra, O J Visser, S Zweegman, G J Ossenkoppele & J J W M Janssen

  2. Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands

    B I Witte

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  1. M J Wondergem
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  2. F S Dijkstra
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  3. O J Visser
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  4. S Zweegman
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Correspondence to M J Wondergem.

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Author contributions

MJW and FSD collected and analyzed the data, JJWMJ, OJV and GJO coordinated the transplants, MJW, FSD and BIW performed the statistical analysis, all authors wrote the manuscript.

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Wondergem, M., Dijkstra, F., Visser, O. et al. Allogeneic transplantation after reduced-intensity conditioning with fludarabine–CY for both indolent and aggressive lymphoid malignancies. Bone Marrow Transplant 49, 513–518 (2014). https://doi.org/10.1038/bmt.2013.221

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