BEAM-alemtuzumab reduced-intensity allogeneic stem cell transplantation for lymphoproliferative diseases: GVHD, toxicity, and survival in 65 patients

被引:135
作者
Faulkner, RD
Craddock, C
Byrne, JL
Mahendra, P
Haynes, AP
Prentice, HG
Potter, M
Pagliuca, A
Ho, A
Devereux, S
McQuaker, G
Mufti, G
Yin, JL
Russell, NH
机构
[1] City Hosp, Dept Haematol, Nottingham NG5 1PB, England
[2] Univ Hosp, Dept Hematol, Birmingham, W Midlands, England
[3] Royal Free Hosp, Dept Haematol, London NW3 2QG, England
[4] Kings Coll Hosp London, Dept Hematol, London, England
[5] Glasgow Royal Infirm, Dept Haematol, Glasgow G4 0SF, Lanark, Scotland
[6] Manchester Royal Infirm, Dept Hematol, Manchester M13 9WL, Lancs, England
关键词
D O I
10.1182/blood-2003-05-1406
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
We report the outcomes of reduced-intensity allogeneic stem cell transplantation using BEAM-alemtuzumab conditioning (carmustine, etoposide, cytosine arabinoside, melphalan, and alemtuzumab 10 mg/d on days -5 to -1) in 6 United Kingdom transplant centers. Sixty-five patients with lymphoproliferative diseases underwent sibling (n=57) or matched unrelated donor (n=8) transplantation. Sustained donor engraftment occurred in 60 (97%) of 62 patients. Of the 56 patients undergoing chimerism studies, 35 (63%) had full donor chimerism. Overall, 73% were in complete remission (CR) after transplantation. At a median follow-up of 1.4 years (range, 0.1-5.6 years), 37 remain alive and in CR. Acute graft-versus-host disease (GVHD) occurred in 11 (117%) of 64, grades I-II only. Estimated 1-year transplantation-related mortality (TRM) was 8% for patients undergoing first transplantation but was significantly worse for those who had previously undergone autologous transplantation. Six patients relapsed (estimated 2-year relapse risk, 20%). Histologic diagnosis (mantle cell lymphoma and high-grade non-Hodgkin lymphoma) and age at transplantation (>46 years) were significantly associated with higher relapse risk and worse event-free survival. Relapse did not occur in any patient who developed acute or chronic GVHD. This study demonstrates that reduced-intensity allogeneic stem cell transplantation for lymphoproliferative diseases using a BEAM-alemtuzumab preparative regimen is associated with sustained donor engraftment, a high response rate, minimal toxicity, and a low incidence of GVHD.
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页码:428 / 434
页数:7
相关论文
共 26 条
[11]  
Kottaridis PD, 2000, BLOOD, V96, P2419
[12]   REPORT OF A COMMITTEE CONVENED TO DISCUSS THE EVALUATION AND STAGING OF PATIENTS WITH HODGKINS-DISEASE - COTSWOLDS MEETING [J].
LISTER, TA ;
CROWTHER, D ;
SUTCLIFFE, SB ;
GLATSTEIN, E ;
CANELLOS, GP ;
YOUNG, RC ;
ROSENBERG, SA ;
COLTMAN, CA ;
TUBIANA, M .
JOURNAL OF CLINICAL ONCOLOGY, 1989, 7 (11) :1630-1636
[13]   The toxicity and efficacy of donor lymphocyte infusions given after reduced-intensity conditioning allogeneic stem cell transplantation [J].
Marks, DI ;
Lush, R ;
Cavenagh, J ;
Milligan, DW ;
Schey, S ;
Parker, A ;
Clark, FJ ;
Hunt, L ;
Yin, J ;
Fuller, S ;
Vandenberghe, E ;
Marsh, J ;
Littlewood, T ;
Smith, GM ;
Culligan, D ;
Hunter, A ;
Chopra, R ;
Davies, A ;
Towlson, K ;
Williams, CD .
BLOOD, 2002, 100 (09) :3108-3114
[14]   Allogeneic peripheral blood stem cell transplantation with reduced-intensity conditioning:: results of a prospective multicentre study [J].
Martino, R ;
Caballero, MD ;
Canals, C ;
Simón, JAP ;
Solano, C ;
Urbano-Ispízua, A ;
Bargay, J ;
Rayón, C ;
Léon, A ;
Sarrá, J ;
Odriozola, J ;
Conde, JG ;
Sierra, J ;
San Miguel, J .
BRITISH JOURNAL OF HAEMATOLOGY, 2001, 115 (03) :653-659
[15]   BEAM CHEMOTHERAPY AND AUTOLOGOUS BONE-MARROW TRANSPLANTATION FOR PATIENTS WITH RELAPSED OR REFRACTORY NON-HODGKINS-LYMPHOMA [J].
MILLS, W ;
CHOPRA, R ;
MCMILLAN, A ;
PEARCE, R ;
LINCH, DC ;
GOLDSTONE, AH .
JOURNAL OF CLINICAL ONCOLOGY, 1995, 13 (03) :588-595
[16]   Allogeneic bone marrow transplant is not better than autologous transplant for patients with relapsed Hodgkin's disease [J].
Milpied, N ;
Fielding, AK ;
Pearce, RM ;
Ernst, P ;
Goldstone, AH .
JOURNAL OF CLINICAL ONCOLOGY, 1996, 14 (04) :1291-1296
[17]  
NAGLER A, 2000, BONE MARROW TRANSPL, V25, P345
[18]   Nonmyeloablative transplantation with or without alemtuzumab:: comparison between 2 prospective studies in patients with lymphoproliferative disorders [J].
Pérez-Simón, JA ;
Kottaridis, PD ;
Martino, R ;
Craddock, C ;
Caballero, D ;
Chopra, R ;
García-Conde, J ;
Milligan, DW ;
Schey, S ;
Urbano-Ispizua, A ;
Parker, A ;
Leon, A ;
Yong, K ;
Sureda, A ;
Hunter, A ;
Sierra, J ;
Goldstone, AH ;
Linch, DC ;
San Miguel, JF ;
Mackinnon, S .
BLOOD, 2002, 100 (09) :3121-3127
[19]  
Prezpiorka D, 1994, BONE MARROW TRANSPL, V15, P825
[20]  
RATANATHARATHORN V, 1994, BLOOD, V84, P1050