The role of hematopoietic stem cell transplantation for relapsed and refractory Hodgkin lymphoma

Abstract

on behalf of the Adult Lymphoma Working Group of the Japanese Society for Hematopoietic Cell TransplantationThe optimal treatment strategy with the use of hematopoietic stem cell transplantation (HSCT) for relapsed and refractory Hodgkin lymphoma (HL) remains unclear. We performed a retrospective analysis using registry data from the Japanese Society for Hematopoietic Cell Transplantation. Adult patients with HL who underwent a first autologous or a first allogeneic HSCT between 2002 and 2009 were included. Patients who underwent HSCT in first complete remission (CR) were excluded. Autologous and allogeneic HSCT were performed in 298 and 122 patients, respectively. For autologous HSCT, overall survival at 3 years (3yOS) was 70%, and sex, age, disease status, and performance status (PS) at HSCT were prognostic factors. OS was favorable even in patients who underwent autologous HSCT in disease status other than CR. For allogeneic HSCT, 3yOS was 43%, and sex and PS at HSCT were prognostic factors. Disease status at HSCT, previous autologous HSCT, and conditioning intensity did not affect OS. Moreover, graft-versus-host disease did not affect progression-free survival or relapse/progression rate. A first allogeneic HSCT without a previous autologous HSCT was performed in 40 patients. 3yOS was 45%, and was significantly inferior to that in patients who underwent their first autologous HSCT. This result was retained after the correction by the different patient characteristics according to the type of HSCT. In conclusion, autologous HSCT is effective in prolonging survival in patients with relapsed and refractory HL. Allogeneic HSCT might be beneficial even to relapsed HL after autologous HSCT, although establishing the role of allogeneic HSCT remains a challenge.

Allogeneic hematopoietic stem cell transplantation in r/r Hodgkin lymphoma after treatment with checkpoint inhibitors: Feasibility and safety

“…Despite higher rate of grade 3-4 acute GVHD (28%; 95% CI, 20%-37%) in cohort 1 than cohort 2 (8%; 95% CI, 6%-10%), our results indicate similar chronic GVHD rates in investigational (26%; 95% CI, 19%-36%) and historical (29%; 95% CI, 26%-31%) arm. Additionally, the rate of NRM (15%; 95% CI, 9%-23%) in cohort 1 is similar to previously reported NRM rate (10%-29%) [9][10][11][12][13][14] in different historical studies without exposure to checkpoint inhibitors. This might be explained by recent improvements in prophylaxis and treatment of GVHD.…”

“…By the end, we had clean data from 6 publications with a total of 122 patients (age median range 18‐75 years) which fulfilled the inclusion criteria (Table ). In the comparator arm (cohort 2), we found 6 publications with 978 patients reporting on acute GVHD and/or NRM rates (Table ). Same selection criteria were applied for both cohorts.…”

Hodgkin’s Lymphoma - evaluation of patients submitted to Autologous transplantation of hematopoietic cells in the Hematology Service of the Hospital Walter Cantídio – Fortaleza, Brazil.

“…Some conditioning regimens suggest adding bortezomib to other drugs, but there was no significant difference in the outcome. 14 The final evaluation of the transplanted HL patients showed an overall survival rate of 88.5% and 61.5% disease-free survival at six years, with an overall survival of chemosensitive patients of 81% and 72.6% in chemoresistant ones, results comparable to other transplant centers 15,16 …”

Evaluation of Autologous Hematopoietic Stem Cell Transplantation Results of the Patients with Hodgkin Lymphoma: A Single Center Experience

“…[4][5][6][7][8][9][10][11][12][13] Unlikely; effects of gender, bone marrow involvement at diagnosis, histology, conditioning regimen, origin of stem cells, mobilization regimen, year of transplantation and immunotherapy were not analyzed in our study. Patient numbers were not enough for making a comparison between groups for some parameters.…”