Alemtuzumab-BEAM as conditioning for allogeneic hematopoietic stem cell transplantation in relapsed/refractory Hodgkin lymphoma: a single-center analysis

Abstract

Purpose Treatment of refractory Hodgkin disease deserves specific considerations. Recently, alemtuzumab-BEAM has been introduced in allogeneic hematopoietic stem cell transplantation (HSCT) in these patients.MethodsWe retrospectively analyzed the outcome of 20 patients with relapsed/refractory Hodgkin’s lymphoma (HL) who received allogeneic HSCT following conditioning therapy with alemtuzumab-BEAM.ResultsTreatment-related toxicity was tolerable. Half of the patients (50 %) had infections. Of these, 50 % were found to have pneumonia or catheter-related infections. In 20 %, an oral mucositis was observed. Acute graft-versus-host disease (GvHD) (≥grade 2) was seen in three patients. Complete remission (CR) could be achieved in 17 patients (85 %), 2 patients had persistent Hodgkin disease, and 1 patient died from infection prior to CR evaluation. Median progression-free survival and overall survival were 17.9 and 67.5 months, respectively. From the 17 CR patients, 8 had a relapse after a median of 10 months. Notably, of the eight patients relapsing after HSCT, all patients received another salvage treatment and four patients are still alive, whereas the other four patients died due to further progress. Six out of the remaining nine patients are still in CR, whereas the other three died from chronic GvHD and multi-organ failure. Overall, seven patients experienced chronic GvHD.ConclusionIn summary, alemtuzumab-BEAM is a well-tolerated conditioning therapy for allogeneic HSCT with high response rates in refractory HL.

Allogeneic hematopoietic stem cell transplantation in r/r Hodgkin lymphoma after treatment with checkpoint inhibitors: Feasibility and safety

“…Despite higher rate of grade 3-4 acute GVHD (28%; 95% CI, 20%-37%) in cohort 1 than cohort 2 (8%; 95% CI, 6%-10%), our results indicate similar chronic GVHD rates in investigational (26%; 95% CI, 19%-36%) and historical (29%; 95% CI, 26%-31%) arm. Additionally, the rate of NRM (15%; 95% CI, 9%-23%) in cohort 1 is similar to previously reported NRM rate (10%-29%) [9][10][11][12][13][14] in different historical studies without exposure to checkpoint inhibitors. This might be explained by recent improvements in prophylaxis and treatment of GVHD.…”

“…By the end, we had clean data from 6 publications with a total of 122 patients (age median range 18‐75 years) which fulfilled the inclusion criteria (Table ). In the comparator arm (cohort 2), we found 6 publications with 978 patients reporting on acute GVHD and/or NRM rates (Table ). Same selection criteria were applied for both cohorts.…”

Impact of graft‐versus‐lymphoma effect on outcomes after reduced intensity conditioned‐alemtuzumab allogeneic haematopoietic stem cell transplantation for patients with mature lymphoid malignancies

“…The indications, outcomes and use of RIC-Alemtuzumabconditioned allo-HSCT in patients with mature lymphoid malignancies are largely unknown and reported in small, heterogeneous cohorts (Faulkner et al, 2004;Morris et al, 2004;Peggs et al, 2007;Rabitsch et al, 2016). Furthermore, the outcomes of prophylactic DLI (p-DLI) in patients at risk of relapse, and therapeutic DLI (t-DLI) in patients following relapse have been reported in small patient cohorts only (Thomson et al, 2008(Thomson et al, , 2010Peggs et al, 2011).…”