Immunologic recovery following autologous stem-cell transplantation with pre- and posttransplantation rituximab for low-grade or mantle cell lymphoma

Y. L. Kasamon, R. J. Jones, R. A. Brodsky, E. J. Fuchs, W. Matsui, L. Luznik, J. D. Powell, A. L. Blackford, A. Goodrich, C. D. Gocke, R. A. Abrams, R. F. Ambinder, I. W. Flinn

Research output: Contribution to journalArticle

Abstract

Background: Rituximab may improve transplant outcomes but may delay immunologic recovery. Patients and methods: Seventy-seven patients with low-grade or mantle cell lymphoma received autologous stemcell transplantation (ASCT) on a phase II study. Rituximab 375 mg/m2 was administered 3 days before mobilizationdose cyclophosphamide, then weekly for four doses after count recovery from ASCT. Immune reconstitution was assessed. Results: Sixty percent of transplants occurred in first remission. Actuarial event-free survival (EFS) and overall survival (OS) were 60% and 73%, respectively, at 5 years, with 7.2-year median follow-up for OS in surviving patients. Median EFS was 8.3 years. Older age and transformed lymphomas were independently associated with inferior EFS, whereas day 60 lymphocyte counts did not predict EFS or late infections. Early and late transplant-related mortality was 1% and 8%, with secondary leukemia in two patients. B-cell counts recovered by 1-2 years; however, the median IgG level remained low at 2 years. Late-onset idiopathic neutropenia, generally inconsequential, was noted in 43%. Conclusion: ASCT with rituximab can produce durable remissions on follow-up out to 10 years. Major infections do not appear to be significantly increased or to be predicted by immune monitoring.

Original languageEnglish (US)
Pages (from-to)1203-1210
Number of pages8
JournalAnnals of Oncology
Volume21
Issue number6
DOIs
StatePublished - Oct 30 2009

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Keywords

  • Immune reconstitution
  • Lymphoma
  • Rituximab
  • Transplantation

ASJC Scopus subject areas

  • Hematology
  • Oncology

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