Gentler chemotherapy before stem cell transplant causes long-term
remission of follicular lymphoma
ATLANTA - Treating relapsed follicular lymphoma patients with a
milder chemotherapy regimen before they receive a blood stem cell
transplant from a donor resulted in long-term complete remission for
45 of 47 patients in a clinical trial, researchers at The University
of Texas M. D. Anderson Cancer Center report at the 49th annual
meeting of the American Society of Hematology.
The two patients who had relapsed after the treatment regained a
complete response after additional therapy.
"Our results show that this approach may actually be curative of
follicular lymphoma," says lead author Issa Khouri, M.D., professor
in M. D. Anderson's Department of Stem Cell Transplantation. "No
other treatments produce this type of response."
The traditional treatment before receiving a matched stem cell
donation consists of higher-dose chemotherapy that kills the lymphoma
cells and shuts down the patient's own blood-producing stem cells - a
process called myeloablation. While waiting for the donor's stem
cells to engraft in the bone marrow and to begin producing blood,
patients are vulnerable to infection, bleeding, and anemia.
Early research by Khouri and colleagues indicated that using a
nonmyeloablative chemotherapy approach could control the lymphoma
while sparing patients the side effects of high-dose chemotherapy.
The transplanted blood stem cells launch an immune system attack on
the lymphoma, a process called graft-vs.-lymphoma immunity.
"Our early results were encouraging. But with follicular lymphoma you
need a long follow-up to see if the results hold," Khouri says. "This
disease tends to recur later on, sometimes years after chemotherapy.
All patients in the present trial have been followed for at least
five years, some for up to nine years. Trial patients had received 2
to 7 different chemotherapy regimens. Eight had received transplants
of their own stem cells. At transplantation, 29 were in partial
remission and 18 were in complete remission.
All 47 achieved complete remission after receiving matched blood stem
cells from donors. One patient relapsed at 18 months. After receiving
a donor lymphocyte infusion, the patient began a continuous complete
response at 24 months. The other patient relapsed at 20 months and
was found to have graft failure. Since treatment with rituximab, this
patient has been in complete remission for four years.
Seven patients died during the trial, none from follicular lymphoma,
Khouri notes. The 40 remaining patients all remain in remission.
Overall survival at six years is 85 percent and current progression-
free survival is 83 percent.
Acute graft-vs.-host disease (GVHD) arose in 11 percent of patients.
Another 51 percent had chronic graft-vs.-host disease. GVHD was
treated with immunosuppressive therapy. Khouri notes that only five
patients in the study group remain on immunosuppressive therapy.
Long-term follow-up also allowed researchers to thoroughly gauge side
effects, or toxicity, of the non-myeloablative approach. "It reduces
toxicity significantly,
this done."
Patients received fludarabine, cyclophosphamide and rituximab for
three days before transplantation. Tacrolimus and methotrexate were
used to prevent graft-vs.-host disease.
Follicular lymphoma is a Non-Hodgkin lymphoma, with about 12,000 new
cases diagnosed annually.
###
Co-authors with Khouri are Rima M. Saliba, Martin Korbling, Chitra
Hosing, Luis Fayad, Ming S. Lee, Felipe Samaniego, Barry I. Samuels,
Daniel Couriel, Fredrick Hagemeister, Peter McLaughlin and Richard
Champlin, all of M. D. Anderson.
Public release date: 10-Dec-2007
[ Print Article | E-mail Article | Close Window ]
Contact: Scott Merville
sdmervil@mdanderson
713-516-4855
University of Texas M. D. Anderson Cancer Center
http://www.eurekale
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StemCells subscribers may also be interested in these sites:
Children's Neurobiological Solutions
http://www.CNSfoundation.org/
Cord Blood Registry
http://www.CordBlood.com/at.cgi?a=150123
The CNS Healing Group
http://groups.yahoo.com/group/CNS_Healing
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