Superiority of reduced-intensity allogeneic transplantation over conventional treatment for relapse of Hodgkin's lymphoma following autologous stem cell transplantation

Abstract

This study compares outcome of reduced-intensity conditioned transplant (RIT) with outcome of conventional nontransplant therapy in patients with Hodgkin's lymphoma relapsing following autograft. There were 72 patients in two groups who had relapsed, and received salvage therapy with chemotherapy ± radiotherapy. One group (n ¼ 38) then underwent alemtuzumab-containing RIT. The second group-historical controls (n ¼ 34), relapsing before the advent of RIT-had no further high-dose therapy. This group was required to respond to salvage therapy and live for over 12 months post-relapse, demonstrating potential eligibility for RIT, had this been available. Overall survival (OS) from diagnosis was superior following RIT (48% at 10 years versus 15%; P ¼ 0.0014), as was survival from autograft (65% at 5 years versus 15%; Pp0.0001). For the RIT group, OS at 5 years from allograft was 51%, and in chemoresponsive patients was 58%, with current progression-free survival of 42%. Responses were seen in 8 of 15 patients receiving donor lymphocyte infusions (DLI) for relapse/progression, with durable remission in five patients at median follow-up from DLI of 45 months . These data demonstrate the potential efficacy of RIT in heavily pretreated patients whose outlook with conventional therapy is dismal, and provide evidence of a clinically relevant graft-versus-lymphoma effect.

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

“…The difference between OS and PFS might be attributed to the effectiveness of salvage therapy including allogeneic HSCT, which was difficult to evaluate precisely because information as to the performance of allogeneic HSCT after relapse/ progression was lacking in a part of patients. Allogeneic HSCT should be effective in prolonging OS even for relapsed HL after autologous HSCT, compared to conventional therapy [14]. In our study, 3y OS was 43% in all patients who underwent allogeneic HSCT, including those who had a previous autologous HSCT ( Fig.…”

“…This study was planned by the Adult Lymphoma Working Group of JSHCT, and was approved by the data management committee of TRUMP and by the institutional review board of Nagoya University School of Medicine. 12 Department of Hematology and Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan; 13 Department of Hematopoietic Stem Cell Transplantation Data Management and Biostatistics, Nagoya University School of Medicine, Nagoya, Japan; 14 Cancer Center, Shimane University Hospital, Shimane, Japan Statistical considerations. Differences between groups were examined using Fisher's exact test for categorical variables.…”

Second hematopoietic SCT for lymphoma patients who relapse after autotransplantation: another autograft or switch to allograft?

“…[48][49][50][51][52][53][54][55][56][57][58][59][60][61][62] The rationale behind this strategy is to decrease the high TRM observed after myeloablative allo-SCT, though preserving the GVT effect. In addition, RIC allo-SCT allows patients with significant coexistent medical problems to undergo allo-SCT.…”

Outcomes of reduced-intensity conditioning allo-SCT for Hodgkin's lymphoma: a national review by the Canadian Blood and Marrow Transplant Group

“…Thomson et al 9 performed a retrospective matched comparison of patients undergoing RICallo with historical controls who had survived for at least 1 year following relapse after ASCT, and the reported survival was improved both from the time of diagnosis and after ASCT in RIC-allo patients. Although these data are interesting, it is hypothesis generating and suffers from the usual methodological limitations of retrospective cohort comparisons.…”