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Annals of Oncology Advance Access published online on October 30, 2009
Annals of Oncology, doi:10.1093/annonc/mdp484
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© The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

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{dagger}, R. F. Ambinder and I. W. Flinn{ddagger}

Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA

* Correspondence to: Dr Y. L. Kasamon, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, CRB 388, 1650 Orleans Street, Baltimore, MD 21231, USA. Tel: +1-410-955-8839; Fax: +1-410-955-0960; E-mail: ykasamo1{at}jhmi.edu

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 stem-cell transplantation (ASCT) on a phase II study. Rituximab 375 mg/m2 was administered 3 days before mobilization-dose 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.

immune reconstitution, lymphoma, rituximab, transplantation

{dagger} Present address: Rush University Medical Center, Chicago, IL, USA.

{ddagger} Present address: Sarah Cannon Research Institute, Nashville, TN, USA.

Received for publication June 1, 2009. Revision received August 17, 2009. Accepted for publication September 9, 2009.


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