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The role of in vivo T-cell depletion on reduced-intensity conditioning allogeneic stem cell transplantation from HLA-identical siblings in patients with follicular lymphoma

Leukemia volume 25, pages 551–555 (2011)Cite this article

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In spite of the undoubtedly improved outcome in the rituximab era, there is not evidence as yet that immunochemotherapy will eventually cure a significant proportion of patients with follicular lymphoma (FL). Stem cell transplantation (SCT) has been explored with the aim of improving the clinical outcome of FL patients and, hopefully, to offer the chance of cure. Several randomized studies have evaluated the role of autologous SCT (auto-SCT), both in first or second remission, and showed an improved progression-free survival (PFS) compared with conventional chemotherapy, but with no definitive benefit in terms of overall survival (OS).1 The procedure is well tolerated with a low non-relapse mortality (NRM) of around 5%. Although a few series with a very long follow-up suggest the existence of a plateau in the PFS curve and, hence, that cure may be possible,2 many patients will eventually relapse.

In contrast, myeloablative allogeneic SCT (allo-SCT) can result in long-term disease control owing, in part, to the graft-versus-lymphoma (GVL) effect, but is associated with a NRM in excess of 30% owing to direct conditioning regimen toxicity and graft-versus-host disease (GVHD).3 As a result, reduced-intensity conditioning (RIC) regimens were devised to take advantage of the GVL effect while reducing the toxicity of conventional regimens.4 However, there is still much debate with regard to the most appropriate RIC regimen for these patients. Furthermore, RIC regimens possibly have less direct toxicity compared with myeloablative regimens, but GVHD still remains a significant cause of morbidity and mortality in this population. Some cooperative groups have added alemtuzumab or antithymocyte globulin (ATG) to the conditioning regimen to deplete recipient and incoming donor T cells and provide sustained engraftment while reducing GVHD rates. This reduced GVHD rate is, however, counterbalanced by a delayed post-SCT immune reconstitution and a higher relapse rate.5 Interestingly, a recent evidence-based review sponsored by the American Society of Blood and Marrow Transplantation identified the use of T-cell-depleted allo-SCT as one of the areas where research is most needed in patients with FL.6

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Acknowledgements

We are indebted to Dr Peter Dreger for his valuable comments and suggestions. This study was partially supported by unrestricted grants from Bayer Schering Pharma and Genzyme.

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Authors and Affiliations

  1. Department of Hematology, Servicio de Hematologia Clinica, Hospital de la Santa Creu i Sant Pau, Barcelona, Cataluna, Spain,

    J Delgado, R Martino & A Sureda

  2. EBMT Office, Barcelona, Spain

    C Canals & A Sureda

  3. Department of Hematology, Hopital Purpan, Toulouse, France

    M Attal

  4. Department of Hematology, University College Hospital, London, UK

    K Thomson

  5. Bone Marrow Transplantation Unit, Instituto Portugues de Oncologia, Porto, Portugal

    A Campos

  6. Department of Hematology, Radcliffe Hospital, Oxford, UK

    T Littlewood

  7. Department of Hematology, Royal Victoria Infirmary, Newcastle, UK

    G Jackson

  8. Department of Hematology, Hopital Haut-Leveque, Pessac, France

    N Milpied

  9. Department of Hematology, University Hospital Gasthuisberg, Leuven, Belgium

    M Boogaerts

  10. Department of Hematology, Leicester Royal Infirmary, Leicester, UK

    A Hunter

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

    J J W M Janssen

  12. Department of Hematology, St Bartholomew's Hospital, London, UK

    S Montoto

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Correspondence to J Delgado.

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Competing interests

Dr Julio Delgado has received lecturing fees from Bayer Schering Pharma. All other authors declare no conflict of interest.

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Delgado, J., Canals, C., Attal, M. et al. The role of in vivo T-cell depletion on reduced-intensity conditioning allogeneic stem cell transplantation from HLA-identical siblings in patients with follicular lymphoma. Leukemia 25, 551–555 (2011). https://doi.org/10.1038/leu.2010.292

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