Fludarabine (famp)-based chemotherapy at conventional doses allows engraftment of allogeneic (allo) peripheral blood progenitor cell (pbpc) transplantation in chronic lymphocytic leukemia (cll)

Engraftment of PBPC can confer a graft-vs-leukemia effect which is important to achieve durable remissions. Achieving engraftment with a nontoxic preparative regimen may decrease toxîcity and improve therapeutic results. FAMP is an active agent against CLL and a potent immunosuppressive agent. We used this agent at conventional doses to allow engraftment of PBPC. Two patients were analyzed. Both received PBPC from HLA-identical siblings, infused 2 days post chemotherapy. Both patients received G-CSF 300 -4g SC starting day 0. One was 52 y/o with CLL transformed to large cell lymphoma. He received cis-platinum at 25mg/nWd x 4, FAMP at 30mg/m! at 48,72 hours post cis-platinum, and Ara~C 500 mg/m1 at exactly 4 hours post FAMP. He recovered a neulrophil count of >0.5 X lO'/L at day 25, platelet of >20,000/ml at day 39. He received a boost of 2 x 10 MNC cells/kg at days +60 and +120, Bone marrow (BM) analysis at days +30 and +60 showed 75% and 100% donor cells respectively by RFLP. The other patient studied had CLL in relapse. He received FAMP 30mg/nWd x 3, and cyclophosphamide 350mg/mVd x 3. He never became neutropenic. Skin rash developed at day +21 and biopsy was consistent with acute GVHD, BM analysis at day +30 showed donor cells. These data indicate that conventional therapy with FAMP-based regimen represents a novel approach to allow engraftment of allo PBPC in CLL.