Impact of type of reduced‐intensity conditioning regimen on the outcomes of allogeneic haematopoietic cell transplantation in classical Hodgkin lymphoma

Ahmed, Sairah; Ghosh, Nilanjan; Ahn, Kwang Woo; Khanal, Manoj; Litovich, Carlos; Mussetti, Alberto; Chhabra, Saurabh; Cairo, Mitchell S.; Mei, Matthew; William, Basem M.; Nathan, Sunita; Bejanyan, Nelli; Olsson, Richard F.; Dahi, Parastoo B.; Poel, Marjolein van der; Steinberg, Amir; Kanakry, Jennifer A.; Černý, Jan; Farooq, Umar; Seo, Sachiko; Kharfan‐Dabaja, Mohamed A.; Sureda, Anna; Fenske, Timothy S.; Hamadani, Mehdi

doi:10.1111/bjh.16664

Cited by 21 publications

(16 citation statements)

References 37 publications

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“…96 Some patients have relentlessly progressive disease and have been treated with tandem autologous stem-cell transplantation 97 or allogeneic transplantation, including haploidentical transplants. 98,99 The data suggests that these therapies are feasible, but toxicity and relapses are common.…”

Section: Primary Refractory Diseasementioning

confidence: 99%

Hodgkin lymphoma: 2023 update on diagnosis, risk‐stratification, and management

Ansell

2022

American J Hematol

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Disease Overview: Hodgkin lymphoma (HL) is an uncommon B-cell lymphoid malignancy affecting 8540 new patients annually and representing approximately 10% of all lymphomas in the United States. Diagnosis: HL is composed of two distinct disease entities: classical HL and nodular lymphocyte-predominant HL. Nodular sclerosis, mixed cellularity, lymphocyte depletion, and lymphocyte-rich HL are subgroups of classical HL.Risk Stratification: An accurate assessment of the stage of disease in patients with HL is critical for the selection of the appropriate therapy. Prognostic models that identify patients at low or high risk for recurrence, as well as the response to therapy as determined by positron emission tomography scan, are used to optimize therapy.Risk-Adapted Therapy: Initial therapy for HL patients is based on the histology of the disease, the anatomical stage, and the presence of poor prognostic features.Patients with early-stage disease are typically treated with combined modality strategies utilizing abbreviated courses of combination chemotherapy followed by involved-field radiation therapy, while those with advanced-stage disease receive a longer course of chemotherapy, often without radiation therapy. However, newer agents, including brentuximab vedotin and anti-programmed death-1 (PD-1) antibodies, are now being incorporated into frontline therapy.Management of Relapsed/Refractory Disease: High-dose chemotherapy (HDCT) followed by an autologous stem cell transplant (ASCT) is the standard of care for most patients who relapse following initial therapy. For patients who fail HDCT with ASCT, brentuximab vedotin, PD-1 blockade, non-myeloablative allogeneic transplant, or participation in a clinical trial should be considered.

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Section: Primary Refractory Diseasementioning

confidence: 99%

Hodgkin lymphoma: 2023 update on diagnosis, risk‐stratification, and management

Ansell

2022

American J Hematol

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“…Although the RIC regimens are generally associated with a lower cumulative incidence of non‐relapse mortality (NRM) relative to myeloablative conditioning (MAC) regimens, disease relapse remains the most common cause of treatment failure in patients with lymphoma undergoing allo‐HCT. Retrospective studies comparing conditioning regimen intensities, including predominantly patients with B‐cell NHL or classic Hodgkin lymphoma, generally show higher NRM rates, with high‐intensity conditioning without a consistent survival benefit 14,17–22 …”

Section: Introductionmentioning

confidence: 99%

“…Retrospective studies comparing conditioning regimen intensities, including predominantly patients with B-cell NHL or classic Hodgkin lymphoma, generally show higher NRM rates, with high-intensity conditioning without a consistent survival benefit. 14,[17][18][19][20][21][22] There are sparse data directly comparing clinical outcomes of patients who have undergone RIC/NMA versus MAC allo-HCT for mature T-cell NHL. 23 Using the observational database of the Centre for International Blood and Marrow Transplant Research (CIBMTR), we report here the outcomes of PTCL-NOS, AITL and ALCL patients, according to the intensity of allo-HCT conditioning regimens.…”

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confidence: 99%

Impact of conditioning regimen intensity on the outcomes of peripheral T‐cell lymphoma, anaplastic large cell lymphoma and angioimmunoblastic T‐cell lymphoma patients undergoing allogeneic transplant

et al. 2022

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Summary There have been no large studies comparing reduced‐intensity/non‐myeloablative conditioning (RIC/NMA) to myeloablative conditioning (MAC) regimens in T‐cell non‐Hodgkin lymphoma (T‐NHL) patients undergoing allogeneic transplant (allo‐HCT). A total of 803 adults with peripheral T‐cell lymphoma, anaplastic large cell lymphoma and angioimmunoblastic T‐cell lymphoma (age 18–65 years), undergoing allo‐HCT between 2008–2019 and reported to the Center for International Blood and Marrow Transplant Research with either MAC (n = 258) or RIC/NMA regimens (n = 545) were evaluated. There were no significant differences between the two cohorts in terms of patient sex, race and performance scores. Significantly more patients in the RIC/NMA cohort had peripheral blood grafts, haematopoietic cell transplantation‐specific comorbidity index (HCT‐CI) of ≥3 and chemosensitive disease compared to the MAC cohort. On multivariate analysis, overall survival (OS) was not significantly different in the RIC/NMA cohort compared to the MAC cohort (hazard ratio (HR) = 1.01, 95% confidence interval (CI) = 0.79–1.29; p = 0.95). Similarly, non‐relapse mortality (NRM) (HR = 0.85, 95% CI = 0.61–1.19; p = 0.34), risk of progression/relapse (HR = 1.29; 95% CI = 0.98–1.70; p = 0.07) and therapy failure (HR = 1.14; 95% CI = 0.92–1.41, p = 0.23) were not significantly different between the two cohorts. Relative to MAC, RIC/NMA was associated with a significantly lower risk of grade 3–4 acute graft‐versus‐host disease (HR = 0.67; 95% CI = 0.46–0.99, p = 0.04). Among chemorefractory patients, there was no difference in OS, therapy failure, relapse, or NRM between RIC/NMA and MAC regimens. In conclusion, we found no association between conditioning intensity and outcomes after allo‐HCT for T‐cell NHL.

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“…Unlike the his tor i cal data in which NRM rates were almost 50% and 3-year over all sur vival (OS) 25% to 30%, 37 in the con tem po rary series the NRM rates have declined to approx i ma tely 10%, and 3-year OS is approx i ma tely 60%. 7 These improve ments could be due to bet ter con di tion ing approaches, 7,38 advances in graft-ver sus-host dis ease (GVHD) pre ven tion, and over all advances in sup port ive ASCT, autol o gous hema to poi etic cell trans plan ta tion; DFS, dis ease-free sur vival; DHAP, dexa meth a sone, high-dose cytarabine, cis platin; EFS, event-free sur vival; ESHAP, etoposide, meth yl pred nis o lone, high-dose cytarabine, cis platin; FFP, free dom from pro gres sion; GDP, gemcitabine, dexa meth a sone, cis platin; GVD, gemcitabine, vinorelbine, lipo so mal doxo ru bi cin; ICE, ifosfamide, carboplatin, etoposide; IGEV, ifosfamide, gemcitabine, etoposide, vinorelbine; NA, not appli ca ble; NR, not reported; PFS, pro gres sion-free sur vival.…”

Section: Transplant and Cel Lu Lar Ther Apy Options Allogeneic Hctmentioning

confidence: 99%

“…Unlike patients with relapsed non -Hodgkin lym phoma (NHL; median age in the late 60s), the median age of relapsed cHL patients is typ i cally in the 30s. 6,7 The young age of these R/R patients means that in addi tion to selecting the next sal vage option (typ i cally expected to pro vide short-term dis ease con trol), the treating team must also con sider ther a peu tic modal i ties that can pro vide dura ble dis ease con trol and hope fully cure. The lat ter may not be fea sible for the sub set of dou ble-refrac tory patients with advanced age, com pro mised organ func tion, and/or poor per for mance sta tus.…”

Section: Introductionmentioning

confidence: 99%

Double-refractory Hodgkin lymphoma: tackling relapse after brentuximab vedotin and checkpoint inhibitors

Epperla

Hamadani

2021

Hematology

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The approval of brentuximab vedotin (BV) and checkpoint inhibitors (CPI) has revolutionized the management of relapsed/refractory classical Hodgkin lymphoma (cHL) patients. In recent years these agents have rapidly moved to earlier lines of therapy, including post-autologous hematopoietic cell transplant (auto-HCT) consolidation, pre-HCT salvage, and the frontline treatment setting. This shift in practice means that double-refractory (refractory to both BV and CPI) cHL is becoming an increasingly common clinical problem. In patients who are not eligible for clinical trials, conventional cytotoxic and targeted therapies (off label) may be a potential option. In patients who are transplant eligible, early referral to allogeneic HCT should be considered given the significant improvement in transplant outcomes in the contemporary era. Cellular therapy options including CD30.chimeric antigen receptor T cells, Epstein-Barr virus-directed cytotoxic T cells, and CD16A/30 bispecific natural killer cell engagers appear promising and are currently in clinical trials.

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Impact of type of reduced‐intensity conditioning regimen on the outcomes of allogeneic haematopoietic cell transplantation in classical Hodgkin lymphoma

Cited by 21 publications

References 37 publications

Hodgkin lymphoma: 2023 update on diagnosis, risk‐stratification, and management

Hodgkin lymphoma: 2023 update on diagnosis, risk‐stratification, and management

Impact of conditioning regimen intensity on the outcomes of peripheral T‐cell lymphoma, anaplastic large cell lymphoma and angioimmunoblastic T‐cell lymphoma patients undergoing allogeneic transplant

Double-refractory Hodgkin lymphoma: tackling relapse after brentuximab vedotin and checkpoint inhibitors

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