Fludarabine-melphalan as a preparative regimen for reduced-intensity conditioning allogeneic stem cell transplantation in relapsed and refractory Hodgkin's lymphoma: the updated M.D. Anderson Cancer Center experience

Anderlini, Paolo; Saliba, Rima M.; Acholonu, Sandra; Giralt, Sergío; Andersson, Börje S.; Ueno, Naoto T.; Hosing, Chitra; Khouri, Issa F.; Couriel, Daniel R.; Lima, Marcos J.G. de; Qazilbash, Muzaffar H.; Pro, Barbara; Romaguera, Jorge; Fayad, Luis; Hagemeister, Frederick; Younes, Anas; Munsell, Mark F.; Champlin, Richard E.

doi:10.3324/haematol.11828

Cited by 131 publications

(125 citation statements)

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“…3 Furthermore, Anderlini et al recently reported a 2-year PFS rate of 57% in patients who achieved CR/CRu before alloSCT using a similar RIC regimen without alemtuzumab. 2 However, none of those reports described a correlation between FDG-PET findings and outcome.…”

Section: Discussionmentioning

confidence: 98%

“…[1][2][3] RIC regimens also have been investigated in patients with aggressive lymphomas: Most of those studies included various B-cell and T-cell histotypes, and the estimated 3-year PFS rates have been 15% to 20% in patients with chemoresistant disease and 45% to 55% in patients with chemosensitive disease. [4][5][6][7] Chemosensitivity is 1 of the most important prognostic factors affecting final outcomes in patients who receive myeloablative conditioning, and is also important for patients who receive RIC regimens.…”

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confidence: 99%

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Pretransplantation [18‐F]fluorodeoxyglucose positron emission tomography scan predicts outcome in patients with recurrent Hodgkin lymphoma or aggressive non‐Hodgkin lymphoma undergoing reduced‐intensity conditioning followed by allogeneic stem cell transplantation

Dodero

Crocchiolo

Miceli

et al. 2010

Cancer

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BACKGROUND:The use of positron emission tomography (PET) scanning in Hodgkin lymphoma (HL) and aggressive non-Hodgkin lymphoma (HG-NHL) has recognized prognostic value in patients who are receiving chemotherapy or undergoing autologous stem cell transplantation (SCT). In contrast, the role of PET before reduced-intensity conditioning (RIC) and followed by allogeneic SCT has not been investigated to date. METHODS: PET was used to assess 80 patients who had chemosensitive disease (34 patients with HG-NHL and 46 patients with HL) before they underwent allogeneic SCT: 42 patients had negative PET studies, and 38 patients had positive PET studies. Patients underwent allograft from matched related siblings (n ¼ 41) or alternative donors (n ¼ 39). RESULTS: At the time of the last follow-up, 48 patients were alive (60%), and 32 had died. The 3-year cumulative incidence of nonrecurrence mortality and disease recurrence was 17% and 40%, respectively. The cumulative incidence of disease recurrence was significantly lower in the PET-negative patients (25% vs 56%; P ¼ .007), but there was no significant difference between the patients with or without chronic graft-versus-host disease (P ¼ .400). The patients who had negative PET studies before undergoing allogenic SCT also had significantly better outcomes in terms of 3-year overall survival (76% vs 33%; P ¼ .001) and 3-year progression-free survival (73% vs 31%; P ¼ .001). On multivariate analysis, overall survival was influenced by PET status (hazard ratio [HR], 3.35), performance status (HR, 5.15), and type of donor (HR, 6.26 for haploidentical vs sibling; HR, 1.94 for matched unrelated donor vs sibling). CONCLUSIONS: The current results indicated that PET scanning appears to be an accurate tool for assessing prognosis in patients who are eligible for RIC allografting. Cancer 2010;116:5001-11.

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Section: Discussionmentioning

confidence: 98%

mentioning

confidence: 99%

Pretransplantation [18‐F]fluorodeoxyglucose positron emission tomography scan predicts outcome in patients with recurrent Hodgkin lymphoma or aggressive non‐Hodgkin lymphoma undergoing reduced‐intensity conditioning followed by allogeneic stem cell transplantation

Dodero

Crocchiolo

Miceli

et al. 2010

Cancer

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“…[65][66][67] Peggs et al 65 reported on 49 patients (90% failed prior auto-HCT) who received conditioning with fludarabine, melphalan and alemtuzumab prior to allo-HCT. Donor source consisted of MRD in 31 and URD in 18 patients.…”

Section: Monoclonal Antibodiesmentioning

confidence: 99%

“…The first 14 patients received conditioning with fludarabine and CY with or without antithymocyte globulin. 67 Because of early progression, the subsequent 26 patients received fludarabine plus melphalan. 67 Use of melphalan resulted in a higher OS rate at 18 months (73 vs 39%, P ¼ 0.03) and lower NRM (18 vs 30%).…”

Section: Monoclonal Antibodiesmentioning

confidence: 99%

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

Kharfan‐Dabaja

Hamadani

Sibai

et al. 2014

Bone Marrow Transplant

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Hodgkin lymphoma (HL) relapsing after an autologous hematopoietic cell transplant (HCT) poses a therapeutic challenge. In this setting, salvage chemotherapy (for example, gemcitabine-based, ifosfamide-containing and others) or immunotherapy (for example, brentuximab vedotin) is essential as a bridging-cytoreduction strategy to an allogeneic HCT. Myeloablative allogeneic hematopoietic cell transplantation in relapsed HL is associated with high rates of non-relapse mortality. In carefully selected patients with chemosensitive disease, allografting following lower-intensity conditioning regimens can provide durable disease control rates of about 25-35%. Promising early results with haploidentical and umbilical cord transplantation are noteworthy and are expanding this procedure to patients for whom HLA-matched related or unrelated donors are not available. Unfortunately, a significant number of HL patients relapsing after an autologous HCT are not candidates for allografting because of the presence of resistant disease, donor unavailability or comorbidities. Brentuximab vedotin is approved for HL relapsing after a prior autograft. Rituximab and bendamustine are also active in this setting, albeit with short durations of remission. Histone deacetylase inhibitors (for example, panobinostat, mocetinostat), mTOR inhibitors (for example, everolimus) and immunomodulatory agents (lenalidomide) have shown activity in phase II trials, but currently are not approved for this indication. Second autologous HCT are rarely performed but this approach should not be considered standard practice at this time. The need for effective agents for post autograft failures of HL largely remains unmet. Continuous efforts to ensure early referral of such patients for allogeneic HCT or investigational therapies are the key to improving outcomes of this not-so-good lymphoma.

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Hematopoietic Cell Transplantation for Hodgkin Disease

Bierman

Nademanee

2015

Thomas’ Hematopoietic Cell Transplantation

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Fludarabine-melphalan as a preparative regimen for reduced-intensity conditioning allogeneic stem cell transplantation in relapsed and refractory Hodgkin's lymphoma: the updated M.D. Anderson Cancer Center experience

Abstract: BackgroundThe role of reduced-intensity conditioning allogeneic stem cell transplantation in relapsed/refractory Hodgkin's lymphoma remains poorly defined. We here present an update of our single-center experience with fludarabine-melphalan as a preparative regimen.

Cited by 131 publications

References 34 publications

Pretransplantation [18‐F]fluorodeoxyglucose positron emission tomography scan predicts outcome in patients with recurrent Hodgkin lymphoma or aggressive non‐Hodgkin lymphoma undergoing reduced‐intensity conditioning followed by allogeneic stem cell transplantation

Pretransplantation [18‐F]fluorodeoxyglucose positron emission tomography scan predicts outcome in patients with recurrent Hodgkin lymphoma or aggressive non‐Hodgkin lymphoma undergoing reduced‐intensity conditioning followed by allogeneic stem cell transplantation

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

Hematopoietic Cell Transplantation for Hodgkin Disease

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