Allogeneic stem cell transplantation improves survival in relapsed Hodgkin lymphoma patients achieving complete remission after salvage treatment

Rivas, Maria Marta; Berro, Mariano; Prates, María Virginia; Yantorno, Sebastian; Fiad, Lorena; Arbelbide, Jorge; Basquiera, Ana Lisa; Ferini, Gonzalo; Garcı́a, Juan José; García, Pablo Andrés; Riera, Leandro; Jarchum, Gustavo; Baso, Alfredo; Real, Juan Jose; Cheever, Martin A.; Jaimovich, Gregorio; Rolón, Juliana Martínez; Foncuberta, Cecilia; Saba, Silvia; Kusminsky, Gustavo; Gatmo,

doi:10.1038/s41409-019-0640-z

Cited by 14 publications

(8 citation statements)

References 44 publications

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“…Namely, the patients with chemosensitive disease fared much better than those who remained chemoresistant-OS at 2 years was 62 vs. 20%, respectively. The 2-year OS for the entire group was 40% and it was in line with other studies [15].…”

Section: Discussionsupporting

confidence: 92%

“…Multivariate analysis has demonstrated that the incidence of GVHD was reduced in patients with a longer interval between CPI treatment and transplantation [14]. It was proved that the attainment of chemosensitivity before transplantation remains the main goal of our therapeutic approaches and translates into the success of the procedure [9][10][11]15]. That was also true for our small analysis.…”

Section: Discussionsupporting

confidence: 52%

“…One patient developed primary graft failure (PGF), then underwent second allo-SCT but eventually died due to infectious complications (urosepsis) shortly after the second allotransplantation. All other patients were engrafted after a median of 18 days (range [13][14][15][16][17][18][19][20][21][22][23][24]. Platelet count of >20 × 10 9 / L was demonstrated for 21 patients after median of 13 days (range 8-23).…”

Section: Posttransplant Outcomementioning

confidence: 99%

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Allogeneic Stem Cell Transplantation for Relapsed and Refractory Hodgkin Lymphoma: Real World Experience of a Single Center

Kopińska

Koclęga

Wieczorkiewicz-Kabut

et al. 2021

Pathol. Oncol. Res.

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Introduction: Refractory and relapsed Hodgkin lymphoma (R/R HL) is associated with poor prognosis, and allogeneic stem cell transplantation (allo-SCT) remains the only potentially curative approach.Aim: The aim of the study was to evaluate the feasibility of allotransplantation in R/R HL setting.Material: Overall, 24 patients (17 men and 7 women) at a median age of 27 years (range 18–44) underwent allo-SCT between 2002 and 2020.Results: Nineteen patients received prior autologous stem cell transplantation (ASCT1) whereas eight patients received second ASCT (ASCT2) after failure of ASCT1. Six patients received only brentuximab vedotin (BV; n = 4) or BV followed by checkpoint inhibitors (CPI; n = 2) before entering allo-SCT. Median time from ASCT1 to allo-SCT was 17.1 months. Fifteen patients received grafts from unrelated donors. Peripheral blood was a source of stem cells for 16 patients. Reduced-intensity conditioning was used for all patients. Disease status at transplant entry was as follows: complete remission (CR; n = 4), partial response (PR; n = 10), and stable disease (SD; n = 10). Acute and chronic graft-versus-host disease (GVHD) developed in 13 (54%) and 4 (16%) patients, respectively. Median follow-up for the entire cohort was 13.3 months. At the last follow-up, 17 (71%) patients died. The main causes of death were disease progression (n = 10), infectious complications (n = 6), and steroid-resistant GVHD (n = 1). Non-relapse mortality at 12 months was 25%. At the last follow-up, seven patients were alive; six patients were in CR, and one had PR. The 2-year overall survival (OS) was 40%.Conclusion: Chemosensitive disease at transplant was associated with better outcome. Allo-SCT allows for long-term survival in refractory and relapsed HL.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 52%

Section: Posttransplant Outcomementioning

confidence: 99%

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Allogeneic Stem Cell Transplantation for Relapsed and Refractory Hodgkin Lymphoma: Real World Experience of a Single Center

Kopińska

Koclęga

Wieczorkiewicz-Kabut

et al. 2021

Pathol. Oncol. Res.

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“…More than 70% of patients with HL are cured with initial therapy [14,15]. Autologous and AlloSCT may be curative for about half of patients with relapsed disease, but minimal disease burden is generally required to optimize outcomes [16][17][18]. Transplant is less successful for patients whose disease is chemotherapy resistant or multiply relapsed [19].…”

Section: Discussionmentioning

confidence: 99%

Checkpoint Blockade Treatment May Sensitize Hodgkin Lymphoma to Subsequent Therapy

et al. 2020

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Background. Targeted therapies and checkpoint blockade therapy (CBT) have shown efficacy for patients with Hodgkin lymphoma (HL) in the relapsed and refractory (R/R) setting, but once discontinued owing to progression or side effects, it is unclear how successful further therapies will be. Moreover, there are no data on optimal sequencing of these treatments with standard therapies and other novel agents. In a multicenter, retrospective analysis, we investigated whether exposure to CBT could sensitize HL to subsequent therapy. Materials and Methods. Seventeen centers across the U.S. and Canada retrospectively queried medical records for eligible patients. The primary aim was to evaluate the overall response rate (ORR) to post-CBT treatment using the Lugano criteria. Secondary aims included progressionfree survival (PFS), duration of response, and overall survival (OS). Results. Eighty-one patients were included. Seventy-two percent had stage III-IV disease, and the population was heavily pretreated with a median of four therapies before CBT. Most patients (65%) discontinued CBT owing to progression. The ORR to post-CBT therapy was 62%, with a median PFS of 6.3 months and median OS of 21 months. Post-CBT treatment regimens consisted of chemotherapy (44%), targeted agents (19%), immunotherapy (15%), transplant conditioning (14%), chemotherapy/targeted combination (7%), and clinical trials (1%). No significant difference in OS was found when stratified by post-CBT regimen. Conclusion. In a heavily pretreated R/R HL population, CBT may sensitize patients to subsequent treatment, even after progression on CBT. Post-CBT regimen category did not impact OS. This may be a novel treatment strategy, which warrants further investigation in prospective clinical trials.

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“…A CIBMTR analysis that included 1,694 patients with R/R HL undergoing alloHCT between 2009 and 2019 showed improved rates of 3-year OS in patients with a pre-transplantation CR or PR compared to those deemed chemoresistant (SD or PD) (67% vs. 50%, p<0.0001) ( 12 ). Similarly, a multi-center retrospective analysis from GATMO (Grupo Argentino de Transplante de Médula Ósea) that included 113 patients with R/R cHL undergoing alloHCT showed that CR as compared to PR or SD/PD at the time of transplantation was associated with improved OS in univariate analysis (2-year OS for CR 57%, PR 41%, SD/PD 13%, p=0.001) and was the only variable predictive of OS in multivariate analysis (p=0.002) ( 97 ).…”

Section: The Role Of Allogenic Transplantmentioning

confidence: 99%

The role of transplantation in Hodgkin lymphoma

Maranzano

Mead

2023

Front. Oncol.

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Despite the success of frontline anthracycline-based chemotherapy for classical Hodgkin Lymphoma (cHL), approximately 15% of patients do not achieve an adequate response and require further therapy. For transplant-eligible patients, additional treatment followed by high-dose chemotherapy and autologous hematopoietic stem cell transplantation (autoHCT) provides a durable response in 50% of patients. The most refractory patients, including those requiring multiple lines of therapy to achieve a response or those relapsing after an autoHCT, may achieve long-term survival with allogeneic hematopoietic stem cell transplant (alloHCT). Contemporary salvage regimens used as a bridge to transplant have expanded to include not only non-cross resistant chemotherapy, but also brentuximab vedotin (BV) and checkpoint inhibitors (CPI). As the management of relapsed/refractory (R/R) cHL evolves with the introduction of novel agents, so too does the role of transplantation. The paradigm of chemosensitivity as a predictor for autoHCT efficacy is being challenged by favorable post- autoHCT outcomes in heavily pre-treated CPI-exposed patients. Contemporary supportive care measures, validated comorbidity assessments, and an increased donor pool with haploidentical donors have broadened the application of transplantation to an increasingly older and diverse patient population. Despite the introduction of increasingly effective treatment options for R/R cHL, transplantation continues to play an important role in the management of these patients. In this review, we explore the impact of salvage therapy on autoHCT, conditioning regimens, maintenance therapy and the diminishing role of alloHCT for patients with cHL.

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Allogeneic stem cell transplantation improves survival in relapsed Hodgkin lymphoma patients achieving complete remission after salvage treatment

Cited by 14 publications

References 44 publications

Allogeneic Stem Cell Transplantation for Relapsed and Refractory Hodgkin Lymphoma: Real World Experience of a Single Center

Allogeneic Stem Cell Transplantation for Relapsed and Refractory Hodgkin Lymphoma: Real World Experience of a Single Center

Checkpoint Blockade Treatment May Sensitize Hodgkin Lymphoma to Subsequent Therapy

The role of transplantation in Hodgkin lymphoma

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