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Epperla N, Ahn KW, Ahmed S, Jagasia M, DiGilio A, Devine SM, Jaglowski S, Kennedy V, Rezvani AR, Smith SM, Sureda A, Fenske TS, Kharfan-Dabaja MA, Armand P, Hamadani M. Rituximab-containing reduced-intensity conditioning improves progression-free survival following allogeneic transplantation in B cell non-Hodgkin lymphoma. J Hematol Oncol 2017; 10:117. [PMID: 28606176 PMCID: PMC5469142 DOI: 10.1186/s13045-017-0487-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 06/02/2017] [Indexed: 11/10/2022] Open
Abstract
Background In B cell non-Hodgkin lymphoma (B-NHL), rituximab-containing reduced-intensity conditioning regimens (R-RIC) have been shown to provide favorable outcomes in single-arm studies; however, large multicenter studies comparing R-RIC and non-rituximab-containing reduced-intensity conditioning regimens (nonR-RIC) have not been performed. Using the CIBMTR database, we report the outcomes of R-RIC versus nonR-RIC regimens in B-NHL. Methods We evaluated 1401 adult B-NHL patients undergoing allogeneic hematopoietic cell transplantation (allo-HCT) who received nonR-RIC (n = 1022) or R-RIC (n = 379) regimens. Graft-versus-host disease (GVHD) prophylaxis was limited to calcineurin inhibitor-based approaches. Results Median follow-up of survivors in the R-RIC and nonR-RIC groups was 47 and 37 months, respectively. On multivariate analysis, no difference was seen between the R-RIC and nonR-RIC cohorts in terms of acute GVHD grade II–IV (RR = 1.14, 95%CI = 0.83–1.56, p = 0.43) or grade III–IV (RR = 1.16, 95%CI = 0.72–1.89, p = 0.54), chronic GVHD (RR = 1.15, 95%CI = 0.92–1.46, p = 0.22), non-relapse mortality (RR = 0.90; 95%CI = 0.67–1.22; p = 0.51), relapse/progression (RR = 0.79; 95%CI = 0.63–1.01; p = 0.055), and mortality (RR = 0.84, 95%CI = 0.69–1.02, p = 0.08) risk. However, R-RIC was associated with a significantly improved progression-free survival (RR = 0.76; 95%CI 0.62–0.92; p = 0.006). On subgroup analysis, mortality benefit was noted in the R-RIC group patients not receiving busulfan-based RIC (RR = 0.76; 95%CI = 0.60–0.96; p = 0.02) and with the use of a higher cumulative rituximab dose (RR = 0.43; 95%CI = 0.21–0.90; p = 0.02). Conclusion Our analysis shows that inclusion of rituximab in RIC regimens improves progression-free survival in patients with B cell NHL. These data supports the use of R-RIC in B-NHL patients undergoing allo-HCT. Electronic supplementary material The online version of this article (doi:10.1186/s13045-017-0487-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Narendranath Epperla
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kwang Woo Ahn
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sairah Ahmed
- Department of Stem Cell Transplantation, MD Anderson Cancer Center, Houston, TX, USA
| | - Madan Jagasia
- Division of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alyssa DiGilio
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Steven M Devine
- Division of Hematology, The Ohio State University Medical Center, Columbus, OH, USA
| | - Samantha Jaglowski
- Division of Hematology, The Ohio State University Medical Center, Columbus, OH, USA
| | - Vanessa Kennedy
- Division of Blood & Marrow Transplantation, Stanford University, Stanford, CA, USA
| | - Andrew R Rezvani
- Division of Blood & Marrow Transplantation, Stanford University, Stanford, CA, USA
| | - Sonali M Smith
- Section of Hematology/Oncology, The University of Chicago, Chicago, IL, USA
| | - Anna Sureda
- Servei d'Hematologica, Institut Català d'Oncologia, Hospital Duran i Reynals, Barcelona, Spain
| | - Timothy S Fenske
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mohamed A Kharfan-Dabaja
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Phillipe Armand
- Department of Medical Oncology/Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Mehdi Hamadani
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA. .,Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Suite C5500, Milwaukee, WI, 53226, USA.
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Patriarca F, Giaccone L, Onida F, Castagna L, Sarina B, Montefusco V, Mussetti A, Mordini N, Maino E, Greco R, Peccatori J, Festuccia M, Zaja F, Volpetti S, Risitano A, Bassan R, Corradini P, Ciceri F, Fanin R, Baccarani M, Rambaldi A, Bonifazi F, Bruno B. New drugs and allogeneic hematopoietic stem cell transplantation for hematological malignancies: do they have a role in bridging, consolidating or conditioning transplantation treatment? Expert Opin Biol Ther 2017; 17:821-836. [PMID: 28506131 DOI: 10.1080/14712598.2017.1324567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Novel targeted therapies and monoclonal antibodies can be combined with allogeneic stem cell transplantation (allo-SCT) at different time-points: 1) before the transplant to reduce tumour burden, 2) as part of the conditioning in place of or in addition to conventional agents 3) after the transplant to allow long-term disease control. Areas covered: This review focuses on the current integration of new drugs with allo-SCT for the treatment of major hematological malignancies for which allo-SCT has been a widely-adopted therapy. Expert opinion: After having been used as single agent salvage treatments in relapsed patients after allo-SCT or in combination with donor lymphocyte infusions, many new drugs have also been safely employed before allo-SCT as a bridge to transplantation or after it as planned consolidation/maintenance. This era of new drugs has opened new important opportunities to 'smartly' combine 'targeted drugs and cell therapies' in new treatment paradigms that may lead to higher cure rates or longer disease control in patients with hematological malignancies.
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Affiliation(s)
- Francesca Patriarca
- a Hematology, DAME , University Hospital, University of Udine , Udine , Italy
| | - Luisa Giaccone
- b A.O.U. Città della Salute e della Scienza di Torino, Department of Oncology and Department of Molecular Biotechnology and Health Sciences , University of Torino , Torino , Italy
| | - Francesco Onida
- c Hematology, Maggiore Hospital , University of Milano, Milan , Italy
| | | | | | - Vittorio Montefusco
- e Hematology and Bone Marrow Unit , Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
| | - Alberto Mussetti
- e Hematology and Bone Marrow Unit , Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
| | - Nicola Mordini
- f Hematology , S. Croce e Carle Hospital , Cuneo , Italy
| | - Elena Maino
- g Hematology , Hospital of Mestre (Ve) , Mestre (Ve) , Italy
| | - Raffaella Greco
- h Hematology and Bone Marrow Transplantation Unit , IRCCS San Raffaele Scientific Institute , Milano , Italy
| | - Jacopo Peccatori
- h Hematology and Bone Marrow Transplantation Unit , IRCCS San Raffaele Scientific Institute , Milano , Italy
| | - Moreno Festuccia
- b A.O.U. Città della Salute e della Scienza di Torino, Department of Oncology and Department of Molecular Biotechnology and Health Sciences , University of Torino , Torino , Italy
| | - Francesco Zaja
- a Hematology, DAME , University Hospital, University of Udine , Udine , Italy
| | - Stefano Volpetti
- a Hematology, DAME , University Hospital, University of Udine , Udine , Italy
| | - Antonio Risitano
- i Division of Hematology , Federico II University of Naples , Naples , Italy
| | - Renato Bassan
- g Hematology , Hospital of Mestre (Ve) , Mestre (Ve) , Italy
| | - Paolo Corradini
- e Hematology and Bone Marrow Unit , Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
| | | | - Renato Fanin
- a Hematology, DAME , University Hospital, University of Udine , Udine , Italy
| | - Michele Baccarani
- k Hematology , University-Hospital S. Orsola-Malpighi, University of Bologna , Bologna , Italy
| | - Alessandro Rambaldi
- l Hematology and Bone Marrow Transplant Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo , University of Milan , Milan , Italy
| | - Francesca Bonifazi
- k Hematology , University-Hospital S. Orsola-Malpighi, University of Bologna , Bologna , Italy
| | - Benedetto Bruno
- b A.O.U. Città della Salute e della Scienza di Torino, Department of Oncology and Department of Molecular Biotechnology and Health Sciences , University of Torino , Torino , Italy
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Emole JN, Locke FL, Pinilla-Ibarz J. An update on current and prospective immunotherapies for chronic lymphocytic leukemia. Immunotherapy 2016; 7:455-66. [PMID: 25917633 DOI: 10.2217/imt.15.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Chronic lymphocytic leukemia (CLL) is the most common leukemia. Combined agent chemotherapy is the current standard front-line treatment for physically fit patients with CLL. Use of chemotherapy can be complicated by significant toxicity, especially in patients with advanced age or comorbid conditions. Moreover, patients may relapse and become refractory to further chemotherapy. Immunotherapy targets the aberrant immunological processes in CLL without the toxicity of chemotherapy. Immunotherapeutic strategies can also be combined with chemotherapy to improve response rates in this incurable disease. In this review, we evaluate current and future immune-based options in the treatment of CLL.
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Affiliation(s)
- Josephine N Emole
- Department of Malignant Hematology, H Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA
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Mossoba ME, Halverson DC, Kurlander R, Schuver BB, Carpenter A, Hansen B, Steinberg SM, Ali SA, Tageja N, Hakim FT, Gea-Banacloche J, Sportes C, Hardy NM, Hickstein DD, Pavletic SZ, Khuu H, Sabatini M, Stroncek D, Levine BL, June CH, Mariotti J, Rixe O, Fojo AT, Bishop MR, Gress RE, Fowler DH. High-Dose Sirolimus and Immune-Selective Pentostatin plus Cyclophosphamide Conditioning Yields Stable Mixed Chimerism and Insufficient Graft-versus-Tumor Responses. Clin Cancer Res 2015; 21:4312-20. [PMID: 26071480 DOI: 10.1158/1078-0432.ccr-15-0340] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 05/26/2015] [Indexed: 02/07/2023]
Abstract
PURPOSE We hypothesized that lymphoid-selective host conditioning and subsequent adoptive transfer of sirolimus-resistant allogeneic T cells (T-Rapa), when combined with high-dose sirolimus drug therapy in vivo, would safely achieve antitumor effects while avoiding GVHD. EXPERIMENTAL DESIGN Patients (n = 10) with metastatic renal cell carcinoma (RCC) were accrued because this disease is relatively refractory to high-dose conditioning yet may respond to high-dose sirolimus. A 21-day outpatient regimen of weekly pentostatin (P; 4 mg/m(2)/dose) combined with daily, dose-adjusted cyclophosphamide (C; ≤200 mg/d) was designed to deplete and suppress host T cells. After PC conditioning, patients received matched sibling, T-cell-replete peripheral blood stem cell allografts, and high-dose sirolimus (serum trough target, 20-30 ng/mL). To augment graft-versus-tumor (GVT) effects, multiple T-Rapa donor lymphocyte infusions (DLI) were administered (days 0, 14, and 45 posttransplant), and sirolimus was discontinued early (day 60 posttransplant). RESULTS PC conditioning depleted host T cells without neutropenia or infection and facilitated donor engraftment (10 of 10 cases). High-dose sirolimus therapy inhibited multiple T-Rapa DLI, as evidenced by stable mixed donor/host chimerism. No antitumor responses were detected by RECIST criteria and no significant classical acute GVHD was observed. CONCLUSIONS Immune-selective PC conditioning represents a new approach to safely achieve alloengraftment without neutropenia. However, allogeneic T cells generated ex vivo in sirolimus are not resistant to the tolerance-inducing effects of in vivo sirolimus drug therapy, thereby cautioning against use of this intervention in patients with refractory cancer.
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Affiliation(s)
- Miriam E Mossoba
- Experimental Transplantation and Immunology Branch, Center for Cancer Research, NIH, Bethesda, Maryland
| | - David C Halverson
- Experimental Transplantation and Immunology Branch, Center for Cancer Research, NIH, Bethesda, Maryland
| | - Roger Kurlander
- Department of Laboratory Medicine, Clinical Center, NIH, Bethesda, Maryland
| | - Bazetta Blacklock Schuver
- Experimental Transplantation and Immunology Branch, Center for Cancer Research, NIH, Bethesda, Maryland
| | - Ashley Carpenter
- Experimental Transplantation and Immunology Branch, Center for Cancer Research, NIH, Bethesda, Maryland
| | - Brenna Hansen
- Experimental Transplantation and Immunology Branch, Center for Cancer Research, NIH, Bethesda, Maryland
| | | | - Syed Abbas Ali
- Experimental Transplantation and Immunology Branch, Center for Cancer Research, NIH, Bethesda, Maryland
| | - Nishant Tageja
- Experimental Transplantation and Immunology Branch, Center for Cancer Research, NIH, Bethesda, Maryland
| | - Frances T Hakim
- Experimental Transplantation and Immunology Branch, Center for Cancer Research, NIH, Bethesda, Maryland
| | - Juan Gea-Banacloche
- Experimental Transplantation and Immunology Branch, Center for Cancer Research, NIH, Bethesda, Maryland
| | - Claude Sportes
- Georgia Regents University Cancer Center, Augusta, Georgia
| | - Nancy M Hardy
- University of Maryland Greenbaum Cancer Center, Baltimore, Maryland
| | - Dennis D Hickstein
- Experimental Transplantation and Immunology Branch, Center for Cancer Research, NIH, Bethesda, Maryland
| | - Steven Z Pavletic
- Experimental Transplantation and Immunology Branch, Center for Cancer Research, NIH, Bethesda, Maryland
| | - Hanh Khuu
- Department of Transfusion Medicine, Clinical Center, NIH, Bethesda, Maryland
| | - Marianna Sabatini
- Department of Transfusion Medicine, Clinical Center, NIH, Bethesda, Maryland
| | - David Stroncek
- Department of Transfusion Medicine, Clinical Center, NIH, Bethesda, Maryland
| | - Bruce L Levine
- University of Pennsylvania, Abramson Family Cancer Research Center, Philadelphia, Pennsylvania
| | - Carl H June
- University of Pennsylvania, Abramson Family Cancer Research Center, Philadelphia, Pennsylvania
| | - Jacopo Mariotti
- Fondazione IRCCS Instituto Nazionale dei Tumori, Milan, Italy
| | - Olivier Rixe
- University of New Mexico Cancer Center, Albuquerque, New Mexico
| | - Antonio Tito Fojo
- Genitourinary Malignancies Branch, Center for Cancer Research, NIH, Bethesda, Maryland
| | | | - Ronald E Gress
- Experimental Transplantation and Immunology Branch, Center for Cancer Research, NIH, Bethesda, Maryland
| | - Daniel H Fowler
- Experimental Transplantation and Immunology Branch, Center for Cancer Research, NIH, Bethesda, Maryland.
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Chavez JC, Kharfan-Dabaja MA, Kim J, Yue B, Dalia S, Pinilla-Ibarz J, Anasetti C, Locke FL. Genomic aberrations deletion 11q and deletion 17p independently predict for worse progression-free and overall survival after allogeneic hematopoietic cell transplantation for chronic lymphocytic leukemia. Leuk Res 2014; 38:1165-72. [PMID: 24889511 DOI: 10.1016/j.leukres.2014.04.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 04/04/2014] [Accepted: 04/13/2014] [Indexed: 11/26/2022]
Abstract
Chronic lymphocytic leukemia remains incurable despite availability of potent chemoimmunotherapy regimens. Allogeneic hematopoietic cell transplantation (HCT) is the only modality that offers the possibility of cure. To identify predictors of progression-free and overall survival, we evaluated outcomes of 43 consecutive patients who received an allograft for advanced CLL. The majority received a reduced intensity conditioning regimen (n=37). Donors were HLA matched-related (n=18), matched-unrelated (n=15), mismatched-unrelated (n=7), or umbilical cord blood (n=3). The median progression-free (PFS) and overall survival (OS) were 31.4 months and 46.4 months respectively. Twenty (46.5%) patients were alive and in complete remission at a median follow-up of 31.4 months. NRM was higher than previously published series for CLL, likely due to a high burden of comorbidity (22 patients with HCT-CI ≥ 2) and a high proportion receiving HLA mismatched-unrelated donor or umbilical cord blood cells. Presence of del (11q), del(17p), or progressive disease at HCT are independent predictors of worse PFS and OS. New strategies are needed to improve survival outcomes in CLL associated with poor risk cytogenetics.
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Affiliation(s)
- Julio C Chavez
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, USA
| | - Mohamed A Kharfan-Dabaja
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center, Tampa, USA; Department of Oncologic Sciences, University of South Florida, Tampa, USA
| | - Jongphil Kim
- Department of Biostatistics and Biomedical Sciences, H. Lee Moffitt Cancer Center, Tampa, USA
| | - Binglin Yue
- Department of Biostatistics and Biomedical Sciences, H. Lee Moffitt Cancer Center, Tampa, USA
| | - Samir Dalia
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, USA; Department of Oncologic Sciences, University of South Florida, Tampa, USA
| | - Javier Pinilla-Ibarz
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, USA; Department of Oncologic Sciences, University of South Florida, Tampa, USA
| | - Claudio Anasetti
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center, Tampa, USA; Department of Oncologic Sciences, University of South Florida, Tampa, USA
| | - Frederick L Locke
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center, Tampa, USA; Department of Oncologic Sciences, University of South Florida, Tampa, USA.
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Tomblyn MR. Reprint of: A review of cellular therapies for chronic lymphocytic leukemia. Biol Blood Marrow Transplant 2014; 20:S18-S21. [PMID: 24485018 DOI: 10.1016/j.bbmt.2014.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 11/27/2013] [Indexed: 10/25/2022]
Affiliation(s)
- Marcie Riches Tomblyn
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida.
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A Review of Cellular Therapies for Chronic Lymphocytic Leukemia. Biol Blood Marrow Transplant 2014; 20:164-7. [DOI: 10.1016/j.bbmt.2013.11.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 11/27/2013] [Indexed: 11/19/2022]
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Managing Hodgkin lymphoma relapsing after autologous hematopoietic cell transplantation: a not-so-good cancer after all! Bone Marrow Transplant 2014; 49:599-606. [PMID: 24442246 DOI: 10.1038/bmt.2013.226] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 11/27/2013] [Indexed: 01/02/2023]
Abstract
Hodgkin lymphoma (HL) relapsing after an autologous hematopoietic cell transplant (HCT) poses a therapeutic challenge. In this setting, salvage chemotherapy (for example, gemcitabine-based, ifosfamide-containing and others) or immunotherapy (for example, brentuximab vedotin) is essential as a bridging-cytoreduction strategy to an allogeneic HCT. Myeloablative allogeneic hematopoietic cell transplantation in relapsed HL is associated with high rates of non-relapse mortality. In carefully selected patients with chemosensitive disease, allografting following lower-intensity conditioning regimens can provide durable disease control rates of about 25-35%. Promising early results with haploidentical and umbilical cord transplantation are noteworthy and are expanding this procedure to patients for whom HLA-matched related or unrelated donors are not available. Unfortunately, a significant number of HL patients relapsing after an autologous HCT are not candidates for allografting because of the presence of resistant disease, donor unavailability or comorbidities. Brentuximab vedotin is approved for HL relapsing after a prior autograft. Rituximab and bendamustine are also active in this setting, albeit with short durations of remission. Histone deacetylase inhibitors (for example, panobinostat, mocetinostat), mTOR inhibitors (for example, everolimus) and immunomodulatory agents (lenalidomide) have shown activity in phase II trials, but currently are not approved for this indication. Second autologous HCT are rarely performed but this approach should not be considered standard practice at this time. The need for effective agents for post autograft failures of HL largely remains unmet. Continuous efforts to ensure early referral of such patients for allogeneic HCT or investigational therapies are the key to improving outcomes of this not-so-good lymphoma.
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Kharfan-Dabaja MA, Nishihori T, Otrock ZK, Haidar N, Mohty M, Hamadani M. Monoclonal antibodies in conditioning regimens for hematopoietic cell transplantation. Biol Blood Marrow Transplant 2013; 19:1288-300. [PMID: 23618718 DOI: 10.1016/j.bbmt.2013.04.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Accepted: 04/16/2013] [Indexed: 10/26/2022]
Abstract
Monoclonal antibodies are increasingly being incorporated in conditioning regimens for autologous or allogeneic hematopoietic cell transplantation (HCT). The benefit of adding rituximab to autologous HCT regimens is purportedly related to in vivo purging of clonal B cells. Randomized trials comparing the addition (or not) of rituximab to high-dose therapy regimens are lacking. No benefit of standard-dose radioimmunotherapy-based regimens for autografting in aggressive lymphomas was seen in a randomized controlled study. The incorporation of rituximab into allogeneic HCT regimens aims to improve responses while reducing nonrelapse mortality resulting from acute graft-versus-host disease. The optimal dose and administration schedule of rituximab in this setting are unknown, and potentially serious complications from increased infections owing to prolonged (and profound) cytopenias or persistent hypogammaglobulinemia are of concern. Radioimmunotherapy-based conditioning for allografting holds promise as a modality to optimize tumor control and synergize adoptive immunotherapy effects, but it remains experimental at this time. The addition of alemtuzumab to allogeneic HCT regimens is associated with prolonged lymphopenia and impaired immune reconstitution, high relapse rates, and serious infections. The optimal dose and schedule of alemtuzumab to avoid prolonged immune paresis remain elusive. It is anticipated that additional monoclonal antibodies will soon become available that can be incorporated into HCT regimens after safety and clinical efficacy are demonstrated.
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Affiliation(s)
- Mohamed A Kharfan-Dabaja
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center, Tampa, Florida 33612,
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