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Induction of Alloantigen-specific Anergy in Human Peripheral Blood Mononuclear Cells by Alloantigen Stimulation with Co-stimulatory Signal Blockade
Published on: March 14, 2011
Immunomodulatory nonablative conditioning regimen for B-cell lymphoid malignancies
Wichai Chinratanalab1, Nishitha Reddy, John P Greer
1Hematology and Stem Cell Transplantation Section, Division of Hematology/Oncology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
Experimental Hematology
|January 25, 2012
Summary
Fludarabine, cyclophosphamide, and rituximab-based nonablative conditioning followed by allogeneic stem cell transplantation (allo-SCT) shows promise for CD20(+) B-cell malignancies. This approach achieved a 2-year survival rate of 63% in recurrent cases.
Area of Science:
- Hematology
- Oncology
- Immunology
Background:
- Recurrent CD20(+) B-cell lymphoid malignancies present a significant treatment challenge.
- Previous therapies, including autologous stem cell transplantation, were often insufficient.
- Nonablative conditioning regimens are being explored to improve outcomes in these patients.
Purpose of the Study:
- To evaluate the efficacy and safety of fludarabine, cyclophosphamide, and rituximab-based nonablative conditioning followed by allogeneic stem cell transplantation (allo-SCT).
- To assess survival rates, nonrelapse mortality, and graft-versus-host disease (GVHD) in patients with recurrent CD20(+) B-cell lymphoid malignancies.
- To determine the feasibility of this regimen in heavily pretreated patients.
Main Methods:
- Twenty-six patients with recurrent CD20(+) B-cell lymphoid malignancies received nonablative conditioning (fludarabine, cyclophosphamide, rituximab) followed by allo-SCT.
- Patients received either matched related or unrelated donor stem cells.
- Data on survival, progression, GVHD, and rehospitalization were collected and analyzed.
Main Results:
- The 2-year overall survival and progression-free survival rates were estimated at 63%.
- Nonrelapse mortality was 25%, with causes including graft-versus-host disease and infection.
- Grade II-IV acute GVHD occurred in 31% and chronic GVHD in 23% of patients.
Conclusions:
- Fludarabine, cyclophosphamide, and rituximab-based nonablative conditioning allo-SCT is a viable option for patients with recurrent CD20(+) B-cell lymphoid malignancies.
- The regimen demonstrated acceptable survival rates and manageable GVHD.
- Further studies comparing this regimen with other reduced-intensity conditioning strategies are warranted.
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