Umbilical cord blood transplantation in adults with advanced hodgkin's disease: high incidence of post‐transplant lymphoproliferative disease

Abstract

We report the outcome of 30 consecutive patients with Hodgkin disease (HD) who underwent single-unit UCBT. Most (90%) patients had failed previous autologous hematopoietic stem cell transplantation. The conditioning regimens were based on combinations of thiotepa, busulfan, cyclophosphamide or fludarabine, and antithymocyte globulin. The cumulative incidence (CI) of myeloid engraftment was 90% [95% confidence interval (C.I.), 74-98%] with a median of 18 d (range, 10-48). CI of acute graft-versus-host disease (GvHD) grades II-IV was 30% (95% C.I., 17-44%), while the incidence of chronic GVHD was 42% (95% C.I., 23-77%). The non-relapse mortality (NRM) at 100 d and 4 yr was 30% (95% C.I., 13-46%) and 47% (95% C.I., 29-65%), respectively. EBV-related post-transplant lymphoproliferative disease (EBV-PTLD) accounted for more than one-third of transplant-related death, with an estimate incidence of 26% (95% C.I., 9-44). The incidence of relapse at 4 yr was 25% (95% C.I., 9-42%). Four-year event-free survival (EFS) and overall survival (OS) were 28% and 30%, respectively. Despite a high NRM and an unexpected high incidence of EBV-PTLD, UCBT in heavily pretreated HD patients is an option for patients lacking a suitable adult donor, provided the disease is not in refractory relapse.

Frequency, characteristics, and outcome of PTLD after allo‐SCT: A multicenter study from the Spanish group of blood and marrow transplantation (GETH)

“…Difficulties in controlling PTLD and in restoring the immune system after rituximab treatment have been described in earlier reports. 16,36,37 In our study, 9 out of 43 rituximab non-responders were treated with EBV-specific T-cell therapy, with ORR of 40%, confirming that adoptive cellular immunotherapies may induce durable remissions in rituximab-refractory aggressive PTLD, as previously reported. 9,10 We succeeded in identifying risk factors for overall survivalnamely age, type of underlying disease, response to rituximab and standard laboratory tests such as the lymphocyte and platelet counts.…”

Improving outcomes after allogeneic hematopoietic cell transplantation for Hodgkin lymphoma in the brentuximab vedotin era

“…This supports smaller recent studies on UCB HCT in HL, which suggest promising survival in patients lacking a suitable adult donor 38 , but caution about higher risk of lymphoproliferative disorders (PTLD) with use of anti-thymocyte globulin. 39 At our center, we developed a strategy of prospective EBV titer monitoring and treat EBV viremia pre-emptively with rituximab with marked reduction of PTLD. 40 Our data concur with recent registry data on alternative donor use in patients with lymphoma 41 and a review by Messer et al which indicates that unrelated donor and alternative donor sources versus sibling donor allo SCT result in similar outcomes in advanced HL.…”

Management of Epstein-Barr Virus infections and post-transplant lymphoproliferative disorders in patients after allogeneic hematopoietic stem cell transplantation: Sixth European Conference on Infections in Leukemia (ECIL-6) guidelines

“…21 Pooling results from published studies in HSCT recipients suggest that administration of rituximab results in a positive outcome for approximately 90% patients treated pre-emptively, and 65% with EBV-PTLD. 2,3,11,12,19,20,24,27,[51][52][53][54][55][56][57][58][59][60][61][62] Recent data demonstrate that RI, when applied in combination with rituximab, appears to improve the outcome by over 80%. 3 RI used alone as preemptive therapy resulted in a 68% success rate.…”