Tandem autologous-allo-SCT is feasible in patients with high-risk relapsed non-Hodgkin’s lymphoma

Abstract

Allo-SCT is used to exploit GVL effect in high-risk relapsed non-Hodgkin's lymphoma (NHL). Here, we retrospectively analyzed 34 high-risk NHL patients who underwent auto-SCT followed closely by reduced-intensity allo-SCT ('tandem auto-allo') from January 2002 to November 2010. The search for an allogeneic donor was started at the beginning of salvage regimen. Median patients' age was 47 (27-68) years; histotypes were: diffuse large B-cell n ¼ 5, follicular n ¼ 14, transformed follicular n ¼ 4, mantle-cell n ¼ 5, plasmocytoid lymphoma n ¼ 1, anaplastic large T-cell n ¼ 2, peripheral T-cell n ¼ 3. Donors were HLA-identical siblings (n ¼ 29) or 10/10-matched unrelated individuals (n ¼ 5). Median interval between auto-SCT and allo-SCT was 77 days . At a median follow-up of 46 (8-108) months since allo-SCT, 5-year OS is 77% (61-93) and PFS is 68% (51-85). Disease relapse or progression occurred in six patients, 100-day TRM was 0%, 2-year TRM incidence was 6%. In conclusion, tandem transplantation is feasible in high-risk NHL patients having a HLA-identical donor. This approach could represent a suitable therapeutic option for those patients with high-risk NHL potentially benefitting from further therapy after auto-SCT. Donor searches should be started promptly whenever such an approach is chosen. Keywords: non-Hodgkin's lymphoma; tandem; autologous; allogeneic; SCT INTRODUCTION High-dose therapy followed by auto-SCT is the standard of care for most relapsed non-Hodgkin's lymphoma (NHL) patients. 1,2 Unfortunately, relapse after auto-SCT remains the most important cause of treatment failure. Allogeneic hematopoietic SCT (allo-SCT) yields lower relapse rates compared with auto-SCT because of its GVL effect 3-6 but on the other hand, its feasibility could be limited by the TRM. 7,8 Some risk factors have been associated with poor outcome after salvage therapy followed by auto-SCT, 1,2,9-11 underlying the need for improving prognosis of these patients. A tandem autologous-allogeneic transplantation approach could have the advantage of combining cytoreduction with GVL effect with the aim of ameliorating the outcome of those patients for whom high-dose chemotherapy followed by auto-SCT gives unsatisfactory results.The aim of this retrospective study is to evaluate the feasibility and safety of tandem 'auto-allo' in poor prognosis NHL patients.

High-dose melphalan with autologous stem cell support in refractory Hodgkin lymphoma patients as a bridge to second transplant

“…12,[24][25][26] In the setting of double HDC, a prospective study from the former GELA/SFGM group showed that, in the higher-risk group of patients (refractory and with more than two adverse prognostic factors), this approach of the 5-year freedom from second failure and OS was 41% and 52%, respectively, with the better results in those with chemosensitive disease to salvage therapy. 27 In a pilot study adopting the double HDC approach, Fung et al 28 reported that, in refractory or poor-prognosis patients, the 5-year OS, PFS and freedom from progression were 54%, 49% and 55%, respectively.…”

“…[6][7][8][9][10] However, prognosis of HL patients who do not undergo transplantation remains poor; indeed, the importance of an effective salvage therapy mainly resides in the ability to bridge refractory patients to auto-or even allo-SCT when in response of their disease. 11,12 Our group previously reported an overall response rate (ORR) of 81% after high-dose melphalan (HD-PAM), followed by autologous stem cell infusion in 42 lymphoma patients; in that study the response to treatment was evaluated by computed tomography. 13 Those encouraging findings allowed us to continue using the same regimen even after the advent of FDG-PET for the evaluation of response.…”

Hematopoietic Stem Cell Transplantation for Follicular Lymphoma : Optimal Timing and Indication

“…Marseille and Milan groups reported the results of 34 high-risk relapsed NHL patients, including 14 patients with FL, who underwent tandem BEAM or high-dose Mel auto-SCT followed by RIC (Flu + Bu + ATG or Flu + Cy with or without thiotepa) allo-SCT. 58 The 5-year OS and PFS were 77% and 68%, respectively, with a 2-year TRM of 6%. The clinical implications of preceding auto-SCT before RIC allo-SCT should be confirmed by further large-scale studies.…”

Managing Hodgkin lymphoma relapsing after autologous hematopoietic cell transplantation: a not-so-good cancer after all!

“…Introduction of reduced intensity conditioning (RIC) regimens lowered NRM in HL and other diseases, allowing allo-HCT to be offered to a higher proportion of heavily pretreated cases. [48][49][50][51] Myeloablative regimens A NRM exceeding 50% was reported after myeloablative allo-HCT for relapsed HL. [52][53][54] Although many factors influence outcome, such as high number of prior therapies, hence late referrals for allografting, and suboptimal performance status, another reason for such a high mortality rate could be partly attributed to using myeloablative regimens in patients with comorbidities.…”