Long-Term Follow-Up of 90 Y-Ibritumomab Tiuxetan, Fludarabine, and Total Body Irradiation-Based Nonmyeloablative Allogeneic Transplant Conditioning for Persistent High-Risk B Cell Lymphoma

• Published in: Biology of blood and marrow transplantation 2018-11, Vol.24 (11), p.2211
• Main Authors: Puronen, Camille E, Cassaday, Ryan D, Stevenson, Philip A, Sandmaier, Brenda M, Flowers, Mary E, Green, Damian J, Maloney, David G, Storb, Rainer F, Press, Oliver W, Gopal, Ajay K
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antibodies, Monoclonal - pharmacology; Antibodies, Monoclonal - therapeutic use; Female; Follow-Up Studies; Hematopoietic Stem Cell Transplantation - methods; Humans; Lymphoma, B-Cell - drug therapy; Lymphoma, B-Cell - pathology; Lymphoma, B-Cell - therapy; Male; Middle Aged; Transplantation Conditioning - methods; Transplantation, Homologous - methods; Vidarabine - analogs & derivatives; Vidarabine - pharmacology; Vidarabine - therapeutic use; Whole-Body Irradiation - methods
• ISSN: 1523-6536
• DOI: 10.1016/j.bbmt.2018.06.033

Nonmyeloablative allogeneic hematopoietic cell transplantation (HCT) can provide prolonged remissions in patients with advanced B cell lymphoma (B-NHL) via the graft-versus-lymphoma effect, although inferior results are seen in patients with chemoresistant, bulky, or aggressive disease. Radioimmunotherapy can safely induce responses in B-NHL with minimal nonhematologic toxicity. Initial results of Y-ibritumomab tiuxetan-based allografting demonstrated early safety and disease control in nonremission patients but with short follow-up. Here we report the long-term outcomes of patients treated on this study with specific emphasis on patients achieving early remissions. Eleven of 40 patients were alive at a median follow-up of 9 years (range, 5.3 to 10.2). Fourteen (35%) deaths were due to disease progression and 14 (35%) deaths to complications from HCT. One patient died of a Merkel cell carcinoma. The 5-year overall and progression-free survival for patients with indolent B-NHL was 40% and 27.5%, respectively. None of the patients with diffuse large B cell lymphoma was a long-term disease-free survivor regardless of early remission status. Y-ibritumomab tiuxetan-based allografting represents a viable option in patients with indolent histologies. Improved strategies are needed for aggressive B-NHL. The original trial was registered at www.clinicaltrials.gov as NCT00119392.