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dc.contributor.authorBranson, Kate
dc.contributor.authorChopra, Rajesh
dc.contributor.authorKottaridis, Panagiotis D
dc.contributor.authorMcQuaker, Grant
dc.contributor.authorParker, Anne
dc.contributor.authorSchey, Stephen
dc.contributor.authorChakraverty, Ronjon
dc.contributor.authorCraddock, Charles
dc.contributor.authorMilligan, Donald W
dc.contributor.authorPettengell, Ruth
dc.contributor.authorMarsh, Judith C W
dc.contributor.authorLinch, David C
dc.contributor.authorGoldstone, Anthony H
dc.contributor.authorWilliams, Catherine D
dc.contributor.authorMackinnon, Stephen
dc.date.accessioned2009-10-12T12:00:36Z
dc.date.available2009-10-12T12:00:36Z
dc.date.issued2002-10-01
dc.identifier.citationRole of nonmyeloablative allogeneic stem-cell transplantation after failure of autologous transplantation in patients with lymphoproliferative malignancies. 2002, 20 (19):4022-31 J. Clin. Oncol.en
dc.identifier.issn0732-183X
dc.identifier.pmid12351600
dc.identifier.urihttp://hdl.handle.net/10541/84056
dc.description.abstractPURPOSE: Conventional allogeneic stem-cell transplantation (SCT) after a prior failed autograft is associated with a transplant-related mortality rate of 50% to 80%. The aim of the current study was to evaluate the safety and efficacy of sibling, HLA-matched, nonmyeloablative allogeneic SCT with donor lymphocyte infusion (DLI) in patients with lymphoid malignancy after failure of autologous SCT. PATIENTS AND METHODS: A total of 38 patients with refractory, progressive, or relapsed disease after autologous SCT were entered onto this study. The conditioning regimen consisted of the humanized monoclonal antibody CAMPATH-1H, fludarabine, and melphalan. Fifteen of 35 assessable patients received DLI after SCT. RESULTS: Sustained neutrophil engraftment was achieved in 37 recipients, and platelet engraftment was achieved in 35 patients. The estimated transplant-related mortality was 7.9% at day 100 and 20% at 14 months, the median duration of follow-up. Eight patients experienced grade I/II acute graft-versus-host disease (GVHD) after transplantation, but no grade III/IV GVHD was observed in this setting. However, grade III/IV GVHD occurred in seven patients who received DLI. The actuarial overall survival at 14 months was 53%, with a progression-free survival of 50%. DLI produced a further response in three of 15 recipients. CONCLUSION: Nonmyeloablative allogeneic SCT after CAMPATH-1H-containing conditioning is a relatively safe option compared with conventional allogeneic transplantation for patients who have failed previous autologous SCT. The low incidence of early GVHD enabled the subsequent administration of DLI to improve further clinical responses in this poor-risk group of lymphoma and myeloma patients.
dc.language.isoenen
dc.subjectHaematologic Canceren
dc.subjectHaematopoietic Stem Cell Transplantationen
dc.subject.meshAdult
dc.subject.meshFemale
dc.subject.meshGraft vs Host Disease
dc.subject.meshHematologic Neoplasms
dc.subject.meshHematopoietic Stem Cell Transplantation
dc.subject.meshHumans
dc.subject.meshImmunosuppressive Agents
dc.subject.meshLymphocyte Transfusion
dc.subject.meshMale
dc.subject.meshMiddle Aged
dc.subject.meshRisk Factors
dc.subject.meshSurvival Analysis
dc.subject.meshTransplantation Chimera
dc.subject.meshTransplantation Conditioning
dc.subject.meshTransplantation, Autologous
dc.subject.meshTransplantation, Homologous
dc.subject.meshTreatment Outcome
dc.titleRole of nonmyeloablative allogeneic stem-cell transplantation after failure of autologous transplantation in patients with lymphoproliferative malignancies.en
dc.typeArticleen
dc.contributor.departmentCR (UK) Department of Medical Oncology, Christie Hospital, Manchester, United Kingdom.en
dc.identifier.journalJournal of Clinical Oncologyen
html.description.abstractPURPOSE: Conventional allogeneic stem-cell transplantation (SCT) after a prior failed autograft is associated with a transplant-related mortality rate of 50% to 80%. The aim of the current study was to evaluate the safety and efficacy of sibling, HLA-matched, nonmyeloablative allogeneic SCT with donor lymphocyte infusion (DLI) in patients with lymphoid malignancy after failure of autologous SCT. PATIENTS AND METHODS: A total of 38 patients with refractory, progressive, or relapsed disease after autologous SCT were entered onto this study. The conditioning regimen consisted of the humanized monoclonal antibody CAMPATH-1H, fludarabine, and melphalan. Fifteen of 35 assessable patients received DLI after SCT. RESULTS: Sustained neutrophil engraftment was achieved in 37 recipients, and platelet engraftment was achieved in 35 patients. The estimated transplant-related mortality was 7.9% at day 100 and 20% at 14 months, the median duration of follow-up. Eight patients experienced grade I/II acute graft-versus-host disease (GVHD) after transplantation, but no grade III/IV GVHD was observed in this setting. However, grade III/IV GVHD occurred in seven patients who received DLI. The actuarial overall survival at 14 months was 53%, with a progression-free survival of 50%. DLI produced a further response in three of 15 recipients. CONCLUSION: Nonmyeloablative allogeneic SCT after CAMPATH-1H-containing conditioning is a relatively safe option compared with conventional allogeneic transplantation for patients who have failed previous autologous SCT. The low incidence of early GVHD enabled the subsequent administration of DLI to improve further clinical responses in this poor-risk group of lymphoma and myeloma patients.


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