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dc.contributor.authorPeggs, Karl S
dc.contributor.authorHunter, Ann
dc.contributor.authorChopra, Rajesh
dc.contributor.authorParker, Anne
dc.contributor.authorMahendra, Premini
dc.contributor.authorMilligan, Donald W
dc.contributor.authorCraddock, Charles
dc.contributor.authorPettengell, Ruth
dc.contributor.authorDogan, Ahmet
dc.contributor.authorThomson, Kirsty J
dc.contributor.authorMorris, Emma C
dc.contributor.authorHale, Geoff
dc.contributor.authorWaldmann, Herman
dc.contributor.authorGoldstone, Anthony H
dc.contributor.authorLinch, David C
dc.contributor.authorMackinnon, Stephen
dc.date.accessioned2009-08-06T12:13:00Z
dc.date.available2009-08-06T12:13:00Z
dc.date.issued2005-06
dc.identifier.citationClinical evidence of a graft-versus-Hodgkin's-lymphoma effect after reduced-intensity allogeneic transplantation., 365 (9475):1934-41 Lanceten
dc.identifier.issn1474-547X
dc.identifier.pmid15936420
dc.identifier.doi10.1016/S0140-6736(05)66659-7
dc.identifier.urihttp://hdl.handle.net/10541/76515
dc.description.abstractBACKGROUND: In patients with multiply relapsed Hodgkin's lymphoma allogeneic stem-cell transplantation has been limited by prohibitive non-relapse-related mortality rates and by a lack of definitive evidence for a therapeutic graft-versus-tumour effect. Therefore, we aimed to assess the graft-versus-tumour effect of reduced-intensity allogeneic transplantation. METHODS: We undertook reduced-intensity transplantation in 49 patients with multiply relapsed Hodgkin's lymphoma, 44 (90%) of whom had progression of disease after previous autologous transplantation (median age 32 years [range 18-51], number of previous treatment courses was five [range 3-8], and time from diagnosis 4.8 years [range 0.6-4.8]). 31 patients had HLA matched donors who were related and 18 had donors who were unrelated. Median follow-up was 967 days (range 102-2232). The primary endpoints were engraftment, toxic effects, non-relapse-related mortality, incidence of graft-versus-host disease (GVHD), and the toxic effects of adjuvant donor-lymphocyte infusion. FINDINGS: All patients engrafted. Eight of 49 (16%) had grade II-IV acute GVHD and seven (14%) had chronic GVHD before donor-lymphocyte infusion. 16 (33%) patients received donor-lymphocyte infusion from 3 months after transplantation for residual disease or progression. Six (38%) of the 16 developed grade II-IV acute GVHD and five developed chronic GVHD. Nine (56%) showed disease responses after infusion (eight complete, one partial). Non-relapse-related mortality was 16.3% at 730 days (7.2% for patients who had related donors vs 34.1% for those with unrelated donors, p=0.0206). Projected 4 year overall and progression-free survival were 55.7% and 39.0%, respectively (62.0% and 41.5% for related donors). INTERPRETATION: These data show the potential for durable responses in patients who have previously had substantial treatment for Hodgkin's lymphoma. The low non-relapse-related mortality suggests the procedure could be undertaken earlier in the course of the disease.
dc.language.isoenen
dc.subjectHaematopoietic Stem Cell Transplantationen
dc.subject.meshAdolescent
dc.subject.meshAdult
dc.subject.meshDisease Progression
dc.subject.meshGraft vs Host Disease
dc.subject.meshHematopoietic Stem Cell Transplantation
dc.subject.meshHodgkin Disease
dc.subject.meshHumans
dc.subject.meshLymphocyte Transfusion
dc.subject.meshMiddle Aged
dc.subject.meshRecurrence
dc.subject.meshSurvival Rate
dc.subject.meshTransplantation Conditioning
dc.subject.meshTransplantation, Homologous
dc.titleClinical evidence of a graft-versus-Hodgkin's-lymphoma effect after reduced-intensity allogeneic transplantation.en
dc.typeArticleen
dc.contributor.departmentDepartment of Haematology, Royal Free and University College London, UK. kpeggs@hotmail.comen
dc.identifier.journalLanceten
html.description.abstractBACKGROUND: In patients with multiply relapsed Hodgkin's lymphoma allogeneic stem-cell transplantation has been limited by prohibitive non-relapse-related mortality rates and by a lack of definitive evidence for a therapeutic graft-versus-tumour effect. Therefore, we aimed to assess the graft-versus-tumour effect of reduced-intensity allogeneic transplantation. METHODS: We undertook reduced-intensity transplantation in 49 patients with multiply relapsed Hodgkin's lymphoma, 44 (90%) of whom had progression of disease after previous autologous transplantation (median age 32 years [range 18-51], number of previous treatment courses was five [range 3-8], and time from diagnosis 4.8 years [range 0.6-4.8]). 31 patients had HLA matched donors who were related and 18 had donors who were unrelated. Median follow-up was 967 days (range 102-2232). The primary endpoints were engraftment, toxic effects, non-relapse-related mortality, incidence of graft-versus-host disease (GVHD), and the toxic effects of adjuvant donor-lymphocyte infusion. FINDINGS: All patients engrafted. Eight of 49 (16%) had grade II-IV acute GVHD and seven (14%) had chronic GVHD before donor-lymphocyte infusion. 16 (33%) patients received donor-lymphocyte infusion from 3 months after transplantation for residual disease or progression. Six (38%) of the 16 developed grade II-IV acute GVHD and five developed chronic GVHD. Nine (56%) showed disease responses after infusion (eight complete, one partial). Non-relapse-related mortality was 16.3% at 730 days (7.2% for patients who had related donors vs 34.1% for those with unrelated donors, p=0.0206). Projected 4 year overall and progression-free survival were 55.7% and 39.0%, respectively (62.0% and 41.5% for related donors). INTERPRETATION: These data show the potential for durable responses in patients who have previously had substantial treatment for Hodgkin's lymphoma. The low non-relapse-related mortality suggests the procedure could be undertaken earlier in the course of the disease.


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