Reduced-intensity allogeneic stem cell transplantation in relapsed and refractory Hodgkin's disease: low transplant-related mortality and impact of intensity of conditioning regimen

Abstract

Summary:A total of 40 patients with relapsed/refractory Hodgkin's disease (HD) underwent reduced-intensity conditioning (RIC) allogeneic stem cell transplantation (allo-SCT) from an HLA-identical sibling (n ¼ 20) or a matched unrelated donor (n ¼ 20). The median age was 31 years (range 18-58). Disease status at allo-SCT was refractory relapse (n ¼ 14) or sensitive relapse (n ¼ 26). The conditioning regimens were fludarabine-cyclophosphamide7antithymocyte globulin (n ¼ 14), a less intensive regimen, and fludarabinemelphalan (FM) (n ¼ 26), a more intensive one. The two groups had similar prognostic factors. The median time to neutrophil recovery (ie absolute neutrophil count X500/ll) was 12 days (range 10-24). The median time to platelet recovery (ie platelet count X20 000/ll) was 17 days (range 7-132). Day 100 and cumulative (18-month) transplantrelated mortalities (TRMs) were 5 and 22%. Twenty-four patients (60%) are alive (14 in complete remission or complete remission, unconfirmed/uncertain) with a median follow-up of 13 months (4-78). In all, 16 patients expired (TRM n ¼ 8, disease progression n ¼ 8). FM patients had better overall survival (73 vs 39% at 18 months; P ¼ 0.03), and a trend towards better progression-free survival (37 vs 21% at 18 months; P ¼ 0.2). RIC allo-SCT is feasible in relapsed/refractory HD patients with a low TRM. The intensity of the preparative regimen affects survival. Bone Marrow Transplantation (2005) 35, 943-951.

Pretransplant positive positron emission tomography/gallium scans predict poor outcome in patients with recurrent/refractory Hodgkin lymphoma

“…Such patients with positive uptake may need more innovative approaches. 24 Moscowitz et al 10 identified 3 factors before initiating cytoreductive chemotherapy that can predict outcome, including presence of B-symptoms, extranodal disease, and complete remission duration of less than 1 year. In our study, the presence of Bsymptoms and lack of CR/CRu at ASCT were independently predictive of PFS along with BEAM as the conditioning choice and FI results, whereas CR/CRu, radiation therapy, and BEAM were independently predictive for OS.…”

Second hematopoietic SCT for lymphoma patients who relapse after autotransplantation: another autograft or switch to allograft?

“…57,58 The first report, describing some of the best outcome data reported to date and also with long follow-up, included 20 consecutive NHL patients (10 patients with diffuse large cell lymphoma, 5 with mantle cell lymphoma and 5 with follicular lymphoma). 57 Patients were required to have stable or chemosensitive disease in order to be eligible to undergo allo-SCT.…”

“…58 They used two conditioning regimens, fludarabine-CY with or without ATG, or a more intensive fludarabine and melphalan combination; GVHD prophylaxis consisted only of tacrolimus. Day 100 and 18-month cumulative TRM were 5 and 22%, respectively.…”

“…[48][49][50][51][52][53][54][55][56][57][58][59][60][61][62] The rationale behind this strategy is to decrease the high TRM observed after myeloablative allo-SCT, though preserving the GVT effect. In addition, RIC allo-SCT allows patients with significant coexistent medical problems to undergo allo-SCT.…”

Superiority of reduced-intensity allogeneic transplantation over conventional treatment for relapse of Hodgkin's lymphoma following autologous stem cell transplantation

“…4,5 With the advent of reduced-intensity conditioning regimens, there has been renewed interest in allogeneic transplantation in poor-risk patients with HL. 6,7 We previously reported a series of reduced-intensity allogeneic transplant (RIT), where a proportion of patients had failed a previous autograft. This showed encouraging estimated overall survival (OS) of 56% at 4 years with 2-year NRM of 16%.…”