Allogeneic stem cell transplantation with fludarabine-based, less intensive conditioning regimens as adoptive immunotherapy in advanced Hodgkin's disease
P. Anderlini et al., Allogeneic stem cell transplantation with fludarabine-based, less intensive conditioning regimens as adoptive immunotherapy in advanced Hodgkin's disease, BONE MAR TR, 26(6), 2000, pp. 615-620
Citations number
20
Categorie Soggetti
Hematology,"Medical Research Diagnosis & Treatment
Six patients with advanced Hodgkin's disease in which multiple conventional
treatments (median prior chemotherapy regimens: seven), radiation therapy,
and a prior autologous stem cell transplantation (SCT) had failed underwen
t allogeneic SCT following a fludarabine-based conditioning regimen. Median
age was 29 years (22-30), Median time to progression after autologous SCT
was 6 months (4-21), Disease status at transplant was refractory relapse (n
= 3) and sensitive relapse (n = 3). Cell source was filgrastim-mobilized p
eripheral blood stem cells from an HLA-identical sibling (n = 4) or matched
unrelated donor marrow (n = 2), Conditioning regimens were fludarabine-cyc
lophosphamide-antithymocyte globulin (n = 4), fludarabine-melphalan (n = 1)
and fludarabine-cytarabine-idarubicin (n = 1). Myeloid recovery was prompt
, with an absolute neutrophil count greater than or equal to 500/mu l on da
y 12 (11-15). Median platelet recovery to greater than or equal to 20000/mu
l was on day 9 (0-60). Chimerism studies on day 30 indicated 100% donor-de
rived hematopoiesis in 4/5 evaluable patients (4/4 non-progressors). All re
sponders (3/3) have ongoing 100% donor-derived chimerism. Acute graft-versu
s-host disease (GVHD) was diagnosed in 4/6 evaluable patients. Chronic GVHD
was present in 2/4 evaluable patients. There were no regimen-related death
s. Overall day 100 transplant-related mortality was 2/6 (33%). Three patien
ts have expired and three are alive and progression-free with a median foll
ow-up of 9 months (6-26) post transplant. We conclude that allogeneic stem
cell transplantation with fludarabine-based preparative regimens is feasibl
e in these high-risk, heavily pretreated HD patients.