A Phase II study of a nonmyeloablative allogeneic stem cell transplant with peritransplant rituximab in patients with BCell lymphoid malignancies: Favorably durable event-free survival in chemosensitive patients

Craig S. Sauter, Juliet N. Barker, Lauren Lechner, Junting Zheng, Sean M. Devlin, Esperanza B. Papadopoulos, Miguel Angel Perales, Ann A. Jakubowski, Jenna D. Goldberg, Guenther Koehne, Izaskun Ceberio, Sergio Giralt, Andrew D. Zelenetz, Craig Moskowitz, Hugo Castro-Malaspina

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20 Scopus citations

Abstract

The aim of this prospective phase II trial was to determine the safety and efficacy of a nonmyeloablative conditioning program incorporating peritransplant rituximab in patients with CD20+ B cell non-Hodgkin lymphoma (B-NHL) receiving an allogeneic stem cell transplant (allo-SCT). Fifty-one adult B-NHL patients, with a median age of 54years, were treated with cyclophosphamide, fludarabine, and 200cGy of total body irradiation. Rituximab 375mg/m2 was given on day-8 and in 4 weekly doses beginning day+21. Equine antithymocyte globulin was given to recipients of volunteer unrelated donor grafts. Graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporine and mycophenolate mofetil and tacrolimus, sirolimus, and methotrexate in 8 and 43 patients, respectively. Thirty-three patients received grafts from unrelated donors, and 18 received grafts from matched related donors. All patients engrafted. Full donor chimerism in bone marrow and peripheral T cells was seen in 92% and 89% of patients, respectively, at 3months after allo-SCT. The cumulative incidence of grades II to IV acute GVHD at 6months was 25% (95% confidence interval [CI], 13% to 38%) and grades III to IV was 11% (95% CI, 2% to 20%). The 2-year cumulative incidence of chronic GVHD was 29% (95% CI, 15% to 44%). The 2-year event-free and overall survival for all patients was 72% (95% CI, 59% to 85%) and 78% (95% CI, 66% to 90%), respectively. The 2-year event-free survival for chemosensitive patients was 84% (95% CI, 72% to 96%) compared with 30% (95% CI, 2% to 58%) for chemorefractory patients before allo-SCT (P<.001). This nonmyeloablative regimen, with peritransplant rituximab, is safe and effective in patients with B-NHL.

Original languageEnglish (US)
Pages (from-to)354-360
Number of pages7
JournalBiology of Blood and Marrow Transplantation
Volume20
Issue number3
DOIs
StatePublished - Mar 1 2014
Externally publishedYes

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Keywords

  • Allogeneic stem cell transplant
  • Non-Hodgkin lymphoma
  • Nonmyeloablative
  • Rituximab

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Sauter, C. S., Barker, J. N., Lechner, L., Zheng, J., Devlin, S. M., Papadopoulos, E. B., Perales, M. A., Jakubowski, A. A., Goldberg, J. D., Koehne, G., Ceberio, I., Giralt, S., Zelenetz, A. D., Moskowitz, C., & Castro-Malaspina, H. (2014). A Phase II study of a nonmyeloablative allogeneic stem cell transplant with peritransplant rituximab in patients with BCell lymphoid malignancies: Favorably durable event-free survival in chemosensitive patients. Biology of Blood and Marrow Transplantation, 20(3), 354-360. https://doi.org/10.1016/j.bbmt.2013.11.029