Allogeneic peripheral blood stem cell transplantation using a fludarabine-based low intensity conditioning regimen for malignant lymphoma

Relapse is a serious complication following high-dose therapy and autologou s bone marrow transplantation (ABMT) for malignant lymphoma (ML), Allogenei c transplantation (alloSCT) is a therapeutic option. However, it is associa ted with a high incidence of transplant-related organ toxicity and mortalit y. We recently reported fast engraftment and minimal transplant-related tox icity, using fludarabine-based conditioning with reduced amounts of chemoto xic drugs prior to alloSCT, We now present our experience with 23 heavily t reated high risk ML patients who underwent matched alloSCT following the sa me low intensity conditioning. The patients (20 male, three female) were ag ed 13-63 years, Nineteen had NHL and four HD (resistant disease 12, partial remission 11), Five were post ABMT, Twenty-two patients had fully matched sibling donors, and one a fully matched unrelated donor. Engraftment was fa st. There was no rejection or non-engraftment, Organ toxicity was moderate with no liver or renal toxicity >grade II, Four patients developed >grade I I graft-versus-host disease (GVHD). Seven patients died - four of grade III -IV GVHD and severe infections, two of bacterial sepsis, one of pulmonary f ailure. Ten patients are alive after 22.5 (15-37) months, Survival and dise ase-free survival at 37 months are both 40%, Probability of relapse is 26%, These encouraging results suggest that alloSCT following fludarabine-based low intensity conditioning in high-risk patients merits further evaluation .