Efficacy of High-Dose Therapy and Autologous Hematopoietic Cell Transplantation in Gray Zone Lymphoma: A US Multicenter Collaborative Study

Abstract

High-dose therapy (HDT) and autologous hematopoietic cell transplantation (auto-HCT) has been anecdotally prescribed in gray zone lymphoma (GZL), showing encouraging efficacy. We conducted a multicenter retrospective study aimed at assessing outcomes after auto-HCT in 32 patients with GZL treated at 9 transplantation centers in the United States. The median age of patients at transplantation was 38 years (range, 18 to 70 years), and the majority were male (n = 21; 66%). The median number of lines of therapy before transplantation was 2 (range, 1 to 4). BEAM was the most commonly prescribed regimen (n = 23; 72%). The median duration of follow-up for surviving patients was 34 months (range, 1 to 106 months). Median overall survival (OS) was not reached. The 3-year progression-free survival (PFS) and OS for all patients were 69% and 78%, respectively. Three-year PFS and OS were 100% for patients who received only 1 line of therapy before auto-HCT versus 65% (PFS, P = .25) and 75% (OS, P = .39) for those receiving >1 line. The cumulative incidence of relapse/progression was 4% at 1 year post-transplantation and 31% at 3 years post-transplantation. The 3-year nonrelapse mortality was 0%. These findings suggest that HDT and auto-HCT is an effective treatment in patients with GZL. Our findings ideally require confirmation in a larger cohort of patients, preferably in the setting of large prospective multicenter randomized controlled trials. However, we acknowledge that such studies could be difficult to conduct in patients with GZL owing to the disease's rarity. Alternatively, a multicenter prospective study that includes tissue banking and a data registry is warranted to help better understand the biology and natural history of the disease.

Pediatric gray zone lymphoma according to the 2022 WHO classification: An Italian cohort study

“…20 About one third of patients with GZL have primary refractory disease; in our series, two of four patients did not improve or showed partial response to first-line treatment. In relapsed or refractory disease, a variety of therapeutic efforts, including radiotherapy 18 and HSCT, both autologous and allogenic, 17,19,21,22 have been experienced, almost only in adulthood. The use of BV, a CD30-directed antibody conjugate, is an attractive targeted therapy, given the CD30 positivity observed in all GZLs.…”

B-cell lymphoma is unclassifiable, with signs intermediate between diffuse large-cell B-cell lymphoma and Hodgkin lymphoma

“…Частота рецидива/прогрессирования -4% через 1 год и 31% через 3 года после аутоТГСК. Летальные исходы в течение 3 лет наблюдения не отмечены.Таким образом, высокодозную химиотерапию с последующей аутоТГСК можно рассматривать как эффективный метод лечения пациентов с рецидивом НВКЛ или рефрактерным течением заболевания [20].…”