Responses were scored using the standard criteria for patients with lymphoma as described by Cheson et al.6Peripheral blood CD19+lymphocyte levels were generally measured at the same time intervals. study entry experienced continuous molecular remission. The incidence of grade 2-IV acute GVHD was 11%. Only 5 patients were still undergoing immunosuppressive therapy at the time of last follow-up. We believe that the explained results are a step forward toward developing a curative strategy for recurrent follicular lymphoma. == Introduction == Allogeneic stem cell transplantation can result in long-term disease control in patients with follicular lymphoma, in part through an immune-mediated graft-versus-lymphoma effect.1,2A comparative retrospective study showed a significantly lower relapse rate in patients with follicular lymphoma who underwent allogeneic transplantation compared with those who underwent autologous transplantation.3However, the high treatment-related mortality rate of allogeneic transplantation (30%-40%), caused primarily by direct regimen toxicity and a high incidence of severe graft-versus-host disease (GVHD), often offsets any potential survival benefits Nonmyeloablative stem cell transplantation is designed to exploit the graft-versus-lymphoma effect without the attendant toxicity of myeloablative conditioning.4However, the risk of other toxicities and GVHD cannot be underestimated, and long-term effectiveness is not known because long-term follow-up is lacking in earlier studies. The purpose of this study was to address this space of knowledge. We exploited the graft-versus-lymphoma effect by administering a nonmyeloablative conditioning regimen of fludarabine, cyclophosphamide, and rituximab to 47 patients with relapsed follicular lymphoma. Patients were followed for any median of 60 months after transplantation. We found a long-term survival rate of 85%, with low incidences of toxicity and severe GVHD. All patients experienced total remission, with only 2 relapses. Rabbit Polyclonal to Mouse IgG == Methods == In this phase 2 trial, we included patients treated at M. D. Anderson Malignancy Center for relapsed follicular lymphoma between March 1999 and April 2005. Eligibility criteria included patients aged 19 to 70 years who WP1066 experienced chemosensitive relapsed disease, with partial response or better to salvage chemotherapy. Patients were required to have a Zubrod overall performance status score of 2 or lower, serum bilirubin lower than 2 mg/dL, serum creatinine lower than 1.6 mg/dL, no symptomatic cardiac or pulmonary disease, and no active infection; female patients were to be nonpregnant. In addition, patients were required to have a human leukocyte antigen (HLA)compatible sibling donor. An HLA phenotypically identical unrelated donor was chosen only if patients experienced no sibling donors and were not candidates for autologous transplantation. Patients were treated on a single protocol, and all patients enrolled in the trial were included in the analysis. Written informed consent was obtained from all patients in accordance with the Declaration of Helsinki. The study was examined and approved by The University or college of Texas M. D. Anderson Malignancy Center institutional review table. == Clinical evaluation == All lymph node biopsies were reviewed by an experienced hematopathologist to confirm the diagnosis. Patients underwent a physical examination, a complete blood count with differential count, a serum chemistry panel, serum -2 microglobulin measurement, chest radiography, computed WP1066 tomography of the stomach and pelvis, functional WP1066 imaging with positron emission tomography with18F-fluoro-deoxyglucose or Gallium67scans, and bilateral bone marrow aspiration and biopsies with circulation cytometric immunophenotypic analysis. Disease stage was evaluated using Ann Arbor criteria and assigned an International Prognostic Index score.5Patients were evaluated 1, 3, 6, and 12 months after transplantation and every 6 months thereafter. Responses were scored using the standard criteria for patients with lymphoma as explained by Cheson et al.6Peripheral blood CD19+lymphocyte levels were generally measured WP1066 at the same time intervals..
