Allogeneic transplantation using TLI-ATG conditioning for Hodgkin lymphoma after failure of autologous transplantation

Nonmyeloablative TLI-ATG conditioning for allogeneic transplantation: mature follow-up from a large single-center cohort

“…For our heavily pretreated HL cohort, long-term OS was excellent at 78%, and 69% of patients were alive in CR at last follow-up. 24 The majority of patients with CLL or lymphomas with residual disease converted to CR after transplant, and remissions were durable with long-term PFS of 40% in this subgroup. It is unlikely that 8 to 12 Gy TLI alone provided meaningful longterm antitumor activity against these lymphoid malignancies as prior studies indicate that significantly higher doses of 24 to 30 and 30 to 40 Gy are required for durable control of indolent and aggressive lymphomas, respectively.…”

“…Of those patients, 341 have been reported in prior publications, but with limited follow-up. 10,11,[22][23][24]29 Diagnoses included acute myeloid leukemia (AML; n 5 193), MDS (n 5 94), myelofibrosis (n 5 9), chronic myeloid leukemia (CML; n 5 12), acute lymphoblastic leukemia (ALL; n 5 14), chronic lymphocytic leukemia (CLL; n 5 80), NHL (n 5 175), and HL (n 5 35). Fortyfour percent of patients had HLA-MRDs, 41% had HLA-matched unrelated donors (MUDs; matching at 10 of 10 alleles), and 15% had partially HLA-mismatched unrelated donors (MMUDs), matching at 8 to 9 of 10 alleles (including 3% mismatched at HLA-DQB1 only).…”

“…10,11,20,21 Despite the low risk of GVHD, GVT activity is evident, with durable remissions observed in patients with acute and chronic leukemias, 10,11 myelodysplastic syndrome (MDS), myeloproliferative neoplasms, 22 and Hodgkin (HL) and non-Hodgkin (NHLs) lymphomas after failure of autologous HCT. 23,24 In a randomized phase II trial from the Belgian Hematological Society comparing TLI-ATG to low-dose total body irradiation (TBI, 2 Gy) and fludarabine, TLI-ATG was associated with a lower risk of GVHD and NRM and a higher risk of relapse, leading to equivalent overall survival (OS) at 4 years. 21 Herein, we report our single-center experience using TLI-ATG conditioning in a large cohort of patients (N 5 612) with hematologic malignancies, who underwent transplant over a 15-year period.…”

Estudo da genotipagem KIR por sequenciamento de nova geração em doadores HLA compatíveis e o impacto nos desfechos pós-transplante de células-tronco hematopoiéticas

“…Lowsky e colaboradores demonstraram, numa coorte inicial de pacientes com neoplasias hematológicas de origem mieloide e linfoide, baixas taxas de doença do enxerto contra o hospedeiro aguda, mantendo o efeito antitumor do enxerto. Diversos trabalhos descrevendo os resultados desse protocolo se seguiram à publicação inicial [33][34][35][36][37] 39,40 . Trata-se de uma família diversa de células especializadas com a função de proteção contra infecções virais, manutenção da barreira imune placentária e vigilância da transformação maligna das células 41 .…”