Allogeneic bone marrow transplantation for relapsed and refractory Hodgkin’s disease and non-Hodgkin’s lymphoma

Abstract

Summary:characteristics. and high-grade lymphomas, high-dose chemotherapy (HDC) with autologous stem cell rescue (SCR) provides adults (ages 18-60 years; median 36) underwent alloBMT for lymphoma after failure of standard chemolong-term disease-free survival in 40-60% of patients who relapse with chemotherapy-sensitive disease, and has been therapy. Twenty-one had NHL and six had HD (nodular sclerosis). Thirteen patients had primary refractory disshown to be superior to conventional salvage chemotherapy alone. 2 Long-term survival for patients with primary refracease or chemotherapy-resistant relapses; two of these had relapsed after autoBMT. Three patients had tory or chemotherapy-resistant disease treated with HDC and autologous SCR, however, is only about 10%. 3 untested relapses (one of them had relapsed after autoBMT), and 11 had chemotherapy-sensitive relapses.Low-grade lymphomas are indolent disorders with a high rate of response to initial treatment and a median survival Twenty-four received HLA-matched bone marrow from a sibling (one twin); three received haploidentical marduration of 7-9 years. 3 Although aggressive chemotherapy regimens including HDC and autologous SCR in this group row cells. Nine (33%) died from lymphoma. Eleven (41%) died of treatment-related causes. Opportunistic of patients have shown progression-free survival rates of 50%, follow-up has been relatively short. 4,5 Again, patients infections were a substantial problem leading to eight of these deaths (30%). Six patients (22%) survive free with advanced, recurrent or refractory disease have had a very poor prognosis. of lymphoma 17-70 months post-BMT (median, 56 months); four had had sensitive relapses, one had had Several groups have begun examining the role of allogeneic bone marrow transplantation (alloBMT) for those a resistant relapse, and one had had nontested relapse. Three have chronic GVHD (limited in one; extensive in HD/NHL patients who are younger than 60 years of age and have a suitable HLA (human leukocyte antigen) comtwo). One HD patient who had relapsed after autoBMT remains in remission 19 months after alloBMT. No patible donor. Advantages of alloBMT include hematopoietic rescue with tumor-free marrow, the potential for a therapy-related myelodysplasia has been observed. We conclude that alloBMT has substantial morbidity in graft-versus-lymphoma effect leading to a lower incidence of relapse post-transplantation, and lower rates of therapyheavily pretreated lymphoma patients due to acute toxicity, infections and GVHD. However, 22% of our related leukemia. The few studies that have been performed using alloBMT have reported a 25-35% early mortality HD/NHL patients have had long-term disease-free survival.rate, with deaths secondary to graft-versus-host disease (GVHD), as well as regimen-related toxicities and infecKeywords: allogeneic marrow transplantation; Hodgkin's; lymphoma tion. 6 However, lower than expected relapse rates have been observed in surviving patients, thus suggesting the possibility of an immune-...

High-dose therapy with autologous or allogeneic transplantation as salvage therapy for small cleaved cell lymphoma of follicular center cell origin

“…In our series, seven patients (46%) experienced early transplant-related deaths, while an additional patient died of bronciolitis obliterans -organizing pneumonia 32 months after transplantation. Similar transplant-related mortality has been reported by Demirer et al 28 and Dann et al 29 among patients receiving allogeneic transplants as a salvage therapy for Hodgkin's disease, non-Hodgkin's lymphoma, or acute lymphoblastic leukemia. The ultimate value of allogeneic transplantation may, therefore, depend on the ability to decrease transplant-associated mortality.…”

“…Results in previously reported series of allogeneic transplantation in low-grade lymphoma are highly variable. 10,28,29 In a study including 10 patients with refractory or recurrent low-grade lymphoma, van Biesen and associates 10 reported an actuarial survival of 80% among patients receiving allogeneic transplants. Only two of 10 patients experienced transplant-related mortality.…”

“…Accordingly, the use of purged autologous marrow has been advocated 9,26 as has the use of allogeneic marrow. 10,27,28,29 Studies of transplantation in low-grade lymphoma suffer from several methodological problems. Some studies include only a minority of patients with low-grade lymphoma among patients with intermediate-or high-grade lymphoma.…”

Allogeneic bone marrow transplantation in patients with follicular lymphoma: a single center study

“…The engraftment and post-transplantation complications in our study were similar to those reported in the literature. 15,18,29,30 However, the five recorded deaths occurred earlier after BMT (between day 18 and day 255) and were directly due to the transplantation procedure. Two out of 10 evaluable longterm survivors relapsed 63 and 1073 days after transplantation and the remaining patient, with autologous reconstitution, had never been in CR after BMT.…”

Why aren't we performing more allografts for aggressive non-Hodgkin's lymphoma?

“…[19][20][21][22][23][24][25]27,38,44,45 Those refractory to salvage chemotherapy at the time of transplant generally have eventfree survival less than 25%, and in some cases no event-free survival 20,22 because of both increased rates of relapse and increased transplant-related mortality. This pattern is not dissimilar to that seen with autoSCT, suggesting that there is only a limited role for alloSCT to overcome chemoresistance.…”