Myeloablative versus reduced intensity allogeneic stem cell transplantation for relapsed/refractory Hodgkin's lymphoma in recent years: a retrospective analysis of the Lymphoma Working Party of the European Group for Blood and Marrow Transplantation

Abstract

With modern transplant practices, the NRM associated with MAC for HL has strongly decreased, resulting into non-significant improvement of EFS because of a somewhat better disease control compared with RIC transplants. The intensity of conditioning regimens should be considered when designing individual allo-SCT strategies or clinical trials in patients with relapsed/refractory HL.

Should all patients with HL who relapse after ASCT be considered for allogeneic SCT? A consult, yes; a transplant, not necessarily

“…To summarize the phase 1/2 experience with nivolumab and pembrolizumab: (1) .500 patients were treated; phase 1B and 2 studies were undertaken; (2) response rate is 65% to 70% and clinical benefit is .90%; (3) CR rate is 22% by investigator; (4) median duration of response is unclear but .1 year; and (5) major side effect-"itis" occurs and it is usually endocrine or inflammatory. 24,25 In HL as well as many solid tumors, both of these agents are approved and I see little difference between nivolumab and pembrolizumab; the choice to use 1 over another is unclear.…”

“…However, in 2017, we have an array of treatment options for these patients and the kneejerk response is questionable. [1][2][3] Early-stage disease and the need for RT…”

Advances in the pathophysiology and treatment of relapsed/refractory Hodgkin’s lymphoma with an emphasis on targeted therapies and transplantation strategies

“…Consequently, the issue of conditioning intensity may be revised in the future. 184 Despite recent improvements, the optimal conditioning regimen for patients undergoing alloHCT for HL remains undetermined, and relapse continues to be a common cause of treatment failure. Finally, patients who relapse after alloHCT have limited treatment options including donor lymphocyte infusions (DLIs), second alloHCT, radiation therapy and palliative chemotherapy, and, in general, their prognosis is grim.…”

Impact of graft‐versus‐lymphoma effect on outcomes after reduced intensity conditioned‐alemtuzumab allogeneic haematopoietic stem cell transplantation for patients with mature lymphoid malignancies

“…Historically, myeloablative conditioning allo‐HSCT for lymphoid malignancies has been associated with high rates of transplant‐related mortality (TRM) (Ghobadi et al , ). The development of reduced‐intensity conditioned (RIC) regimens has reduced transplant‐related morbidity and GvHD, facilitating broader use of allo‐HSCT in older, more co‐morbid patients (Genadieva‐Stavrik et al , ). However, RIC with Alemtuzumab theoretically risks abrogating GvLymph activity due to T‐cell depletion (Butcher & Collins, ).…”

“…GvHD, facilitating broader use of allo-HSCT in older, more co-morbid patients (Genadieva-Stavrik et al, 2016). However, RIC with Alemtuzumab theoretically risks abrogating GvLymph activity due to T-cell depletion (Butcher & Collins, 2005).…”