Nonmyeloablative allogeneic hematopoietic transplantation: A promising salvage therapy for patients with non-Hodgkin's lymphoma whose disease has failed a prior autologous transplantation

Purpose: Allogeneic transplantation for patients with lymphoma who experience a recurrence after an autologous transplantation has been considered a hazardous therapeutic choice. We investigated the safety and efficacy of nonmyeloablative stem-cell transplantation in these patients. Patients and Methods: Patients were required to have chemosensitive or stable disease. Twenty consecutive patients were treated in two sequential trials. Fifteen patients underwent a preparative regimen of fludarabine (30 mg/m² daily for 3 days), intravenous cyclophosphamide (750 mg/m² daily for 3 days), and rituximab. For the remaining five patients, the conditioning regimen consisted of cisplatin (25 mg/m² continuous infusion daily for 4 days), fludarabine (30 mg/m² daily for 2 days), and cytarabine (1,000 mg/m² daily for 2 days). Tacrolimus and methotrexate were used for graft-versus-host disease prophylaxis. Results: All patients experienced engraftment of donor cells. One patient (5%) experienced grade 2 acute graft-versus-host disease, and no patients experienced a higher grade. One patient experienced disease progression at 115 days post-transplantation and responded to donor lymphocyte infusion. The remaining patients remained disease-free. One patient died at 10.5 months from a fungal infection. With a median follow-up time of 25 months, the estimated 3-year current progression-free survival rate was 95%. Conclusion: These data suggest that nonmyeloablative allogeneic stem-cell transplantation is an effective option in lymphoma patients with chemosensitive or stable disease who experience disease recurrence following autologous transplantation.