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Faisal MS, Hanel W, Voorhees T, Li R, Huang Y, Khan A, Bond D, Sawalha Y, Reneau J, Alinari L, Baiocchi R, Christian B, Maddocks K, Efebera Y, Penza S, Saad A, Brammer J, DeLima M, Jaglowski S, Epperla N. Outcomes associated with allogeneic hematopoietic stem cell transplantation for relapsed and refractory Hodgkin lymphoma in the era of novel agents. Cancer Med 2023; 12:8228-8237. [PMID: 36653918 PMCID: PMC10134314 DOI: 10.1002/cam4.5631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/06/2023] [Accepted: 01/06/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Relapsed or refractory Hodgkin lymphoma (R/R HL) is a challenging disease with limited treatment options beyond brentuximab vedotin and checkpoint inhibitors. Herein we present the time-trend analysis of R/R HL patients who received allogeneic hematopoietic cell transplantation (allo-HCT) at our center from 2001-2017. METHODS The patients were divided into two distinct treatment cohorts: era1 (2001-2010), and era2 (2011-2017). The primary endpoint was overall survival (OS). Secondary endpoints included progression-free survival (PFS), non-relapse mortality (NRM), and cumulative incidence of acute and chronic graft versus host disease (GVHD). RESULTS Among the 51 patients included in the study, 29 were in era1, and 22 were in era2. There was decreased use of myeloablative conditioning in era2 (18% vs. 31%) compared to era1 and 95% of patients in era2 previously received brentuximab Vedotin (BV). Haploidentical donors were seen exclusively in era2 (0% vs. 14%) and more patients received alternative donor transplants (7% vs. 32%) in era2. The 4-year OS (34% vs. 83%, p < 0.001) and 4-year PFS (28% vs. 62%, p = 0.001) were significantly inferior in era1 compared to era2. The incidence of 1-year NRM was lower in era2 compared to era1 (5% vs. 34%, p = 0.06). The cumulative incidence of acute GVHD at day 100 was similar in both eras (p = 0.50), but the incidence of chronic GVHD at 1 year was higher in era2 compared to era1 (55% vs. 21%, p = 0.03). CONCLUSIONS Despite the advent of novel therapies, allo-HCT remains an important therapeutic option for patients with R/R HL.
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Affiliation(s)
- Muhammad Salman Faisal
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA.,Division of Hematology and Medical Oncology, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Walter Hanel
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Timothy Voorhees
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Rui Li
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Ying Huang
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Abdullah Khan
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - David Bond
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Yazeed Sawalha
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - John Reneau
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Lapo Alinari
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Robert Baiocchi
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Beth Christian
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Kami Maddocks
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Yvonne Efebera
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA.,Division of Hematology and Oncology, OhioHealth Bing Cancer Center, Columbus, Ohio, USA
| | - Sam Penza
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Ayman Saad
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Jonathan Brammer
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Marcos DeLima
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Samantha Jaglowski
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Narendranath Epperla
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
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Stem-Cell Transplantation in Adult Patients with Relapsed/Refractory Hodgkin Lymphoma. TRANSPLANTOLOGY 2021. [DOI: 10.3390/transplantology2040038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Although the majority of patients with Hodgkin lymphoma (HL) are cured with initial therapy, in 85–90% of early stage and 70–80% of advanced-stage disease cases, relapse remains a major problem. Autologous stem-cell transplantation (auto-HCT) after salvage chemotherapy is currently considered to be the standard of care for patients who relapse after first-line chemotherapy or for whom first-line treatment fails. The curative capacity of auto-HCT has been improving with the introduction of new drug-based salvage strategies and consolidation strategies after auto-HCT. Allogeneic stem-cell transplantation (allo-HCT) represents a reasonable treatment option for young patients who relapse or progress after auto-HCT and have chemosensitive disease at the time of transplantation. Allo-HCT is a valid treatment strategy for patients with relapse/refractory HL (r/r HL) because the results have improved over time, mainly with the safe combination of allo-HCT and new drugs. Bearing in mind that outcomes after haploidentical stem-cell transplantation (haplo-HCT) are comparable with those for matched sibling donors and matched unrelated donors, haplo-HCT is now the preferred alternative donor source for patients with r/r HL without a donor or when there is urgency to find a donor if a matched related donor is not present. The development of new drugs such as anti-CD 30 monoclonal antibodies and checkpoint inhibitors (CPI) for relapsed or refractory HL has demonstrated high response rates and durable remissions, and challenged the role and timing of HCT. The treatment of patients with HL who develop disease recurrence or progression after allo-HCT remains a real challenge and an unmet need.
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Vassilakopoulos TP, Asimakopoulos JV, Konstantopoulos K, Angelopoulou MK. Optimizing outcomes in relapsed/refractory Hodgkin lymphoma: a review of current and forthcoming therapeutic strategies. Ther Adv Hematol 2020; 11:2040620720902911. [PMID: 32110285 PMCID: PMC7026824 DOI: 10.1177/2040620720902911] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 12/18/2019] [Indexed: 12/21/2022] Open
Abstract
The outcome of patients with relapsed/refractory classical Hodgkin lymphoma (rr-cHL) has improved considerably in recent years owing to the approval of highly active novel agents such as brentuximab vedotin and Programmed Death-1 (PD-1) inhibitors. Although no randomized trials have been conducted to provide formal proof, it is almost undisputable that the survival of these patients has been prolonged. As autologous stem-cell transplantation (SCT) remains the standard of care for second-line therapy of most patients with rr-cHL, optimization of second-line regimens with the use of brentuximab vedotin, or, in the future, checkpoint inhibitors, is promising to increase both the eligibility rate for transplant and the final outcome. The need for subsequent therapy, and especially allogeneic SCT, can be reduced with brentuximab vedotin consolidation for 1 year, while pembrolizumab is also being tested in this setting. Several other drug categories appear to be active in rr-cHL, but their development has been delayed by the appearance of brentuximab vedotin, nivolumab and pembrolizumab, which have dominated the field of rr-cHL treatment in the last 5 years. Combinations of active drugs in chemo-free approaches may further increase efficacy and hopefully reduce toxicity in rr-cHL, but are still under development.
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Affiliation(s)
- Theodoros P. Vassilakopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., Goudi, Athens, 11527, Greece
| | - John V. Asimakopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Kostas Konstantopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Maria K. Angelopoulou
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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Jeon YW, Yoon S, Min GJ, Park SS, Park S, Yoon JH, Lee SE, Cho BS, Eom KS, Kim YJ, Kim HJ, Lee S, Min CK, Lee JW, Cho SG. Clinical Outcomes of Fludarabine and Melphalan With an 800 cGy Total Body Irradiation Conditioning Regimen in Patients With Refractory or Relapsed Aggressive Non-Hodgkin Lymphoma Undergoing Allogeneic Hematopoietic Stem Cell Transplantation. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:345-355.e7. [PMID: 31014757 DOI: 10.1016/j.clml.2019.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 03/14/2019] [Accepted: 03/25/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Allogeneic hematopoietic stem cell transplant with reduced-intensity conditioning is an effective therapeutic option for patients with refractory or relapsed aggressive non-Hodgkin lymphoma (NHL). PATIENTS AND METHODS We retrospectively evaluated survival outcomes and the efficacy of our fludarabine/melphalan/total body irradiation (TBI) (FMT) regimen. A total of 89 patients had received the FMT regimen from 2007 to 2017. RESULTS The majority of patients (n = 81; 91%) belonged to the histologic subtype of aggressive NHL. The estimated 3-year overall survival and disease-free survival for the entire cohort during a median follow-up of 31 months were 47.1% (95% confidence interval, 36%-57%) and 45.4% (95% confidence interval, 35%-56%), respectively. The cumulative incidence rates of relapse and non-relapse mortality at 3 years were 33.1% and 13.8%, respectively. In analyses of risk factors affecting survival outcomes, chemosensitive disease status at transplant (hazard ratio [HR], 2.45; P = .010), delayed relapse after first-line chemotherapy (HR, 2.101; P = .009), no grade III to IV acute graft-versus-host disease (HR, 11.212; P < .001), and mild chronic graft-versus-host disease (HR, 0.448; P = .016) were independent significant predictors of favorable overall survival. Also, similar parameters were related to favorable disease-free survival. All non-hematologic toxicities occurred within 50 days after allogeneic hematopoietic stem cell transplant, and most of the adverse events were tolerable and manageable with a < 30% incidence. CONCLUSION Our FMT regimen shows favorable transplant outcomes with relatively low-risk toxicities, so it may be a promising strategy for patients with relapsed or refractory aggressive NHL.
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Affiliation(s)
- Young-Woo Jeon
- Division of Lymphoma-Myeloma, Catholic Hematology Hospital, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Institute for Translational Research and Molecular Imaging, Catholic Institutes of Medical Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Laboratory of Immune Regulation, Convergent Research Consortium for Immunologic Disease, Seoul St. Mary's Hospital, Seoul, Republic of Korea
| | - Seugyun Yoon
- Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Gi June Min
- Division of Lymphoma-Myeloma, Catholic Hematology Hospital, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung-Soo Park
- Division of Lymphoma-Myeloma, Catholic Hematology Hospital, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Silvia Park
- Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae-Ho Yoon
- Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung-Eun Lee
- Division of Lymphoma-Myeloma, Catholic Hematology Hospital, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Byung-Sik Cho
- Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ki-Seong Eom
- Division of Lymphoma-Myeloma, Catholic Hematology Hospital, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yoo-Jin Kim
- Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hee-Je Kim
- Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seok Lee
- Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chang-Ki Min
- Division of Lymphoma-Myeloma, Catholic Hematology Hospital, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong Wook Lee
- Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seok-Goo Cho
- Division of Lymphoma-Myeloma, Catholic Hematology Hospital, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Institute for Translational Research and Molecular Imaging, Catholic Institutes of Medical Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Laboratory of Immune Regulation, Convergent Research Consortium for Immunologic Disease, Seoul St. Mary's Hospital, Seoul, Republic of Korea.
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Patel DA. Haploidentical Stem Cell Transplantation With Post-Transplantation Cyclophosphamide for Aggressive Lymphomas: How Far Have We Come and Where Are We Going? World J Oncol 2019; 10:1-9. [PMID: 30834047 PMCID: PMC6396776 DOI: 10.14740/wjon1164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 12/14/2018] [Indexed: 01/14/2023] Open
Abstract
Haploidentical hematopoietic stem cell transplantation (haplo-HSCT) with post-transplant cyclophosphamide (PTCy) offers universal donor availability and can potentially cure relapsed or primary refractory Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL). However, a conditioning regimen intensity that balances the graft-versus-lymphoma (GvL) effect with regimen-related toxicities (RRTs) has not yet been optimized. Limited data exist on the management of relapse, which is common post-transplant. Few prospective or randomized control trials have been conducted on lymphoma patients undergoing haplo-HSCT. Therefore, the current review aims to summarize published retrospective data in the field to help guide clinical decision making for high-risk patients. Retrospective studies in the field are characterized by variability in patient population and sample sizes, eligibility criteria, number of prior treatments (e.g., chemotherapy, radiation therapy, and autologous transplant), graft source (bone marrow or peripheral blood), as well as choice and intensity of the conditioning regimen (non-myeloablative, reduced intensity, or myeloablative). Nonetheless, common themes that emerge from the literature include: 1) Enhanced donor availability and selection with haplo-HSCT with success in heterogeneous patient populations; 2) Outcomes that are comparable if not superior to matched related (MRD) or unrelated (MUD) donor transplants; 3) The benefit of PTCy for reducing incidence of relapse and chronic graft-versus-host disease (GvHD); 4) Presence of co-morbidities leading to poorer transplant-related outcomes; and 5) The need for novel approaches to address disease relapse, particularly for patients with active disease at the time of transplant. Excellent transplant-related outcomes with haplo-HSCT with PTCy have been seen for HL and NHL based on retrospective data. Further studies are needed to determine integration with advanced cellular therapy techniques, such as chimeric antigen receptor (CAR) T-cell, antibody drug conjugates, and checkpoint inhibitors. Graft manipulation may be another avenue for future research.
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Affiliation(s)
- Dilan A Patel
- Vanderbilt Ingram Cancer Center, Vanderbilt University School of Medicine, 2220 Pierce Avenue, Nashville, TN 37232, USA.
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Gaudio F, Mazza P, Carella AM, Mele A, Palazzo G, Pisapia G, Carluccio P, Pastore D, Cascavilla N, Specchia G, Pavone V. Outcomes of Reduced Intensity Conditioning Allogeneic Hematopoietic Stem Cell Transplantation for Hodgkin Lymphomas: A Retrospective Multicenter Experience by the Rete Ematologica Pugliese (REP). CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:35-40. [DOI: 10.1016/j.clml.2018.08.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/28/2018] [Accepted: 08/21/2018] [Indexed: 11/17/2022]
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Lowe KL, Mackall CL, Norry E, Amado R, Jakobsen BK, Binder G. Fludarabine and neurotoxicity in engineered T-cell therapy. Gene Ther 2018; 25:176-191. [DOI: 10.1038/s41434-018-0019-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/25/2018] [Accepted: 03/09/2018] [Indexed: 12/13/2022]
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[Preventative and therapeutic relapse strategies after allogeneic hematopoietic stem cell transplantation: Guidelines from the Francophone society of bone marrow transplantation and cellular therapy (SFGM-TC)]. Bull Cancer 2017; 104:S84-S98. [PMID: 29179894 DOI: 10.1016/j.bulcan.2017.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 05/01/2017] [Indexed: 12/20/2022]
Abstract
Disease relapse remains the first cause of mortality of hematological malignancies after allogeneic hematopoietic stem cell transplantation (allo-HCT). The risk of recurrence is elevated in patients with high-risk cytogenetic or molecular abnormalities, as well as when allo-HCT is performed in patients with refractory disease or with persistent molecular or radiological (PET-CT scan) residual disease. Within the frame of the 7th annual workshops of the francophone society for bone marrow transplantation and cellular therapy, the working group reviewed the literature in order to elaborate unified guidelines for the prevention and treatment of relapse after allo-HCT. For high risk AML and MDS, a post transplant maintenance strategy is possible, using hypomethylating agents or TKI anti-FLT3 when the target is present. For Philadelphia positive ALL, there was a consensus for the use of post-transplant TKI maintenance. For lymphomas, there are no strong data on the use of post-transplant maintenance, and hence a preemptive strategy is recommended based on modulation of immunosuppression, close follow-up of donor chimerism, and donor lymphocytes infusion. For multiple myeloma, even though the indication of allo-HCT is controversial, our recommendation is post transplant maintenance using bortezomib, due to its a good toxicity profile without increasing the risk of GVHD.
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Martínez C, Gayoso J, Canals C, Finel H, Peggs K, Dominietto A, Castagna L, Afanasyev B, Robinson S, Blaise D, Corradini P, Itälä-Remes M, Bermúdez A, Forcade E, Russo D, Potter M, McQuaker G, Yakoub-Agha I, Scheid C, Bloor A, Montoto S, Dreger P, Sureda A. Post-Transplantation Cyclophosphamide-Based Haploidentical Transplantation as Alternative to Matched Sibling or Unrelated Donor Transplantation for Hodgkin Lymphoma: A Registry Study of the Lymphoma Working Party of the European Society for Blood and Marrow Transplantation. J Clin Oncol 2017; 35:3425-3432. [DOI: 10.1200/jco.2017.72.6869] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Purpose To compare the outcome of patients with Hodgkin lymphoma who received post-transplantation cyclophosphamide–based haploidentical (HAPLO) allogeneic hematopoietic cell transplantation with the outcome of patients who received conventional HLA-matched sibling donor (SIB) and HLA-matched unrelated donor (MUD). Patients and Methods We retrospectively evaluated 709 adult patients with Hodgkin lymphoma who were registered in the European Society for Blood and Marrow Transplantation database who received HAPLO (n = 98), SIB (n = 338), or MUD (n = 273) transplantation. Results Median follow-up of survivors was 29 months. No differences were observed between groups in the incidence of acute graft-versus-host disease (GVHD). HAPLO was associated with a lower risk of chronic GVHD (26%) compared with MUD (41%; P = .04). Cumulative incidence of nonrelapse mortality at 1 year was 17%, 13%, and 21% in HAPLO, SIB, and MUD, respectively, and corresponding 2-year cumulative incidence of relapse or progression was 39%, 49%, and 32%, respectively. On multivariable analysis, relative to SIB, nonrelapse mortality was similar in HAPLO ( P = .26) and higher in MUD ( P = .003), and risk of relapse was lower in both HAPLO ( P = .047) and MUD ( P < .001). Two-year overall survival and progression-free survival were 67% and 43% for HAPLO, 71% and 38% for SIB, and 62% and 45% for MUD, respectively. There were no significant differences in overall survival or progression-free survival between HAPLO and SIB or MUD. The rate of the composite end point of extensive chronic GVHD and relapse-free survival was significantly better for HAPLO (40%) compared with SIB (28%; P = .049) and similar to MUD (38%; P = .59). Conclusion Post-transplantation cyclophosphamide–based HAPLO transplantation results in similar survival outcomes compared with SIB and MUD, which confirms its suitability when no conventional donor is available. Our results also suggest that HAPLO results in a lower risk of chronic GVHD than MUD transplantation.
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Affiliation(s)
- Carmen Martínez
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
| | - Jorge Gayoso
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
| | - Carmen Canals
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
| | - Hervé Finel
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
| | - Karl Peggs
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
| | - Alida Dominietto
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
| | - Luca Castagna
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
| | - Boris Afanasyev
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
| | - Stephen Robinson
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
| | - Didier Blaise
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
| | - Paolo Corradini
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
| | - Maija Itälä-Remes
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
| | - Arancha Bermúdez
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
| | - Edouard Forcade
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
| | - Domenico Russo
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
| | - Michael Potter
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
| | - Grant McQuaker
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
| | - Ibrahim Yakoub-Agha
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
| | - Christof Scheid
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
| | - Adrian Bloor
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
| | - Silvia Montoto
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
| | - Peter Dreger
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
| | - Anna Sureda
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
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Improving outcomes after allogeneic hematopoietic cell transplantation for Hodgkin lymphoma in the brentuximab vedotin era. Bone Marrow Transplant 2017; 52:697-703. [PMID: 28134921 PMCID: PMC5415418 DOI: 10.1038/bmt.2016.357] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/20/2016] [Accepted: 11/29/2016] [Indexed: 12/18/2022]
Abstract
Allogeneic hematopoietic cell transplantation (allo HCT) remains a valuable alternative for relapsed/refractory (R/R) Hodgkin lymphoma (HL). Data on allo HCT outcomes in the era of new HL therapies are needed. We evaluated 72 R/R HL patients who received reduced intensity conditioning (RIC) allo HCT and compared the time periods 2009-2013 (n=20) to 2000-2008 (n=52). Grafts included HLA-matched sibling (35%), unrelated donor (8%) and umbilical cord blood (UCB, 56%). In recent period, patients more often received brentuximab vedotin (BV, 60% vs 2%), had fewer comorbidities (Sorror index 0: 60% vs 12%) and were in complete remission (50% vs 23%). Median follow-up was 4.4 years. Three-year progression-free survival (PFS) improved for patients treated between 2009-2013 (49%, 95% CI 26-68%) as compared to the earlier era (23%, 95% CI 13-35%, p=0.02). Overall survival (OS) at 3-years was 84% (95% CI 57-94%) vs 50% (95% CI 36-62%, p=0.01), reflecting lower non-relapse mortality and relapse rates. In multivariate analysis mortality was higher among those with chemoresistance (HR 3.83, 95% CI 1.38-10.57), while treatment during the recent era was associated with better OS (HR for period 2009-2013: 0.24, 95% CI 0.07-0.79) and PFS (HR 0.46, 95% CI 0.23-0.92). Allo HCT in patients with R/R HL is now a more effective treatment.
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11
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Five-year survival and durability results of brentuximab vedotin in patients with relapsed or refractory Hodgkin lymphoma. Blood 2016; 128:1562-6. [PMID: 27432875 DOI: 10.1182/blood-2016-02-699850] [Citation(s) in RCA: 279] [Impact Index Per Article: 34.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 06/08/2016] [Indexed: 12/29/2022] Open
Abstract
Presented here are the 5-year end-of-study results from the pivotal phase 2 trial of brentuximab vedotin in patients with relapsed/refractory (R/R) Hodgkin lymphoma (HL) after failed hematopoietic autologous stem cell transplantation. At 5 years, the overall patient population (N = 102) had an estimated overall survival (OS) rate of 41% (95% confidence interval [CI]: 31-51) and progression-free survival (PFS) rate of 22% (95% CI: 13-31). Patients who achieved a complete response (CR) to brentuximab vedotin (N = 34) had estimated OS and PFS rates of 64% (95% CI: 48-80%) and 52% (95% CI: 34-69%), respectively. The median OS and PFS were not reached in CR patients, with 13 patients (38% of all CR patients) remaining in follow-up and in remission at study closure. Of the 13 patients, 4 received consolidative hematopoietic allogeneic stem cell transplant, and 9 (9% of all enrolled patients) remain in sustained CR without receiving any further anticancer therapy after treatment with brentuximab vedotin. Of the patients who experienced treatment-emergent peripheral neuropathy, 88% experienced either resolution (73%) or improvement (14%) in symptoms. These 5-year follow-up data demonstrate that a subset of patients with R/R HL who obtained CR with single-agent brentuximab vedotin achieved long-term disease control and may potentially be cured. The trial was registered at www.clinicaltrials.gov as #NCT00848926.
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12
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Allogeneic hematopoietic stem cell transplantation in Hodgkin lymphoma: a systematic review and meta-analysis. Bone Marrow Transplant 2016; 51:521-8. [PMID: 26726948 DOI: 10.1038/bmt.2015.332] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 11/03/2015] [Accepted: 11/23/2015] [Indexed: 11/08/2022]
Abstract
Allogeneic stem cell transplantation (allo-SCT) outcomes in patients with Hodgkin lymphoma (HL) remain poorly defined. We performed a meta-analysis of allo-SCT studies in HL patients. The primary endpoints were 6-month, 1-year, 2-year and 3-year relapse-free survival (RFS) and overall survival (OS). A total of 42 reports (1850 patients) was included. The pooled estimates (95% confidence interval) for 6-month, 1-year, 2-year and 3-year RFS were 77 (59-91)%, 50 (42-57)%, 37 (31-43)% and 31 (25-37)%, respectively. The corresponding numbers for OS were 83 (75-91)%, 68 (62-74)%, 58 (52-64)% and 50 (41-58)%, respectively. There was statistical heterogeneity among studies in all outcomes. In meta-regression, accrual initiation year in 2000 or later was associated with higher 6-month (P=0.012) and 1-year OS (P=0.046), and pre-SCT remission with higher 2-year OS (P=0.047) and 1-year RFS (P=0.016). In conclusion, outcomes of allo-SCT in HL have improved over time, with 5-10% lower non-relapse mortality and relapse rates, and 15-20% higher RFS and OS in studies that initiated accrual in 2000 or later compared with earlier studies. However, there is no apparent survival plateau, demonstrating the need to improve on current allo-SCT strategies in relapsed/refractory HL.
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Martino M, Festuccia M, Fedele R, Console G, Cimminiello M, Gavarotti P, Bruno B. Salvage treatment for relapsed/refractory Hodgkin lymphoma: role of allografting, brentuximab vedotin and newer agents. Expert Opin Biol Ther 2015; 16:347-64. [PMID: 26652934 DOI: 10.1517/14712598.2015.1130821] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Second-line, salvage chemotherapy followed by high-dose chemotherapy and autologous stem cell transplantation (AUTO-SCT) is the standard of care for patients with relapsed/refractory (R/R) Hodgkin lymphoma (HL). Approximately 50% of patients relapse after AUTO-SCT and their prognosis is generally poor. Brentuximab Vedotin (BV) has demonstrated efficacy in this setting and allogeneic (ALLO)-SCT represents an option with curative potential in this subgroup of patients. AREAS COVERED A systematic review has been conducted to explore the actual knowledge on ALLO-SCT, BV and newer agents in R/R HL. EXPERT OPINION The introduction of BV in clinical practice has significantly improved the management of post-AUTO-SCT relapses and the drug can induce durable remissions in a subset of R/R HL. Allografting select patients has been used to improve clinical outcomes and recent case series have begun to explore BV as a potential 'bridge' to allo-SCT, even though the optimal timing of ALLO-SCT after BV response remains undetermined. However, reduced tumor burden at the time of ALLO-SCT is a key factor to decrease relapse risk. Based on the unique composition of the tumor, more recently new agents such as PD-1 inhibitors have been developed. The potential role of PD-1 inhibitors with ALLO-SCT remains to be explored.
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Affiliation(s)
- Massimo Martino
- a Hematology and Stem Cells Transplantation Unit , CTMO, Azienda Ospedaliera 'BMM' , Reggio , Italy
| | - Moreno Festuccia
- b Division of Hematology, A.O.U. Citta' della Salute e della Scienza di Torino - Presidio Molinette, and Department of Molecular Biotechnology and Health Sciences , University of Torino , Torino , Italy
| | - Roberta Fedele
- a Hematology and Stem Cells Transplantation Unit , CTMO, Azienda Ospedaliera 'BMM' , Reggio , Italy
| | - Giuseppe Console
- a Hematology and Stem Cells Transplantation Unit , CTMO, Azienda Ospedaliera 'BMM' , Reggio , Italy
| | - Michele Cimminiello
- c Hematology and Stem Cell Transplant Unit , Azienda Ospedaliera San Carlo , Potenza , Italy
| | - Paolo Gavarotti
- b Division of Hematology, A.O.U. Citta' della Salute e della Scienza di Torino - Presidio Molinette, and Department of Molecular Biotechnology and Health Sciences , University of Torino , Torino , Italy
| | - Benedetto Bruno
- b Division of Hematology, A.O.U. Citta' della Salute e della Scienza di Torino - Presidio Molinette, and Department of Molecular Biotechnology and Health Sciences , University of Torino , Torino , Italy
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A Phase II Trial of Fludarabine/Melphalan 100 Conditioning Therapy Followed by Allogeneic Hematopoietic Cell Transplantation for Patients With Lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 15:655-63. [DOI: 10.1016/j.clml.2015.08.087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 07/29/2015] [Accepted: 08/24/2015] [Indexed: 11/22/2022]
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Pingali SR, Champlin RE. Pushing the envelope-nonmyeloablative and reduced intensity preparative regimens for allogeneic hematopoietic transplantation. Bone Marrow Transplant 2015; 50:1157-67. [PMID: 25985053 PMCID: PMC4809137 DOI: 10.1038/bmt.2015.61] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 11/17/2014] [Indexed: 12/30/2022]
Abstract
Allogeneic hematopoietic cell transplantation (HCT) was originally developed to allow delivery of myeloablative doses of chemotherapy and radiotherapy. With better understanding of disease pathophysiology, the graft vs malignancy (GVM) effect of allogeneic hematopoietic transplantation and toxicities associated with myeloablative conditioning (MAC) regimens, the focus shifted to developing less toxic conditioning regimens to reduce treatment-related morbidity without compromising survival. Although HCT with MAC is preferred to reduced intensity conditioning (RIC) for most patients ⩽60 years with AML/myelodysplastic syndrome and ALL, RIC and nonmyeloablative (NMA) regimens allow HCT for many otherwise ineligible patients. Reduced intensity preparative regimens have produced high rates of PFS for diagnoses, which are highly sensitive to GVM. Relapse of the malignancy is the major cause of treatment failure with RIC/NMA HCT. Incorporation of novel agents like bortezomib or lenalidomide, addition of cellular immunotherapy and use of targeted radiation therapies could further improve outcome. In this review, we discuss commonly used RIC/NMA regimens and promising novel regimens.
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Affiliation(s)
- S R Pingali
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - R E Champlin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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16
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Allogeneic hematopoietic cell transplantation after failed autologous transplant for lymphoma using TLI and anti-thymocyte globulin conditioning. Bone Marrow Transplant 2015; 50:1286-92. [PMID: 26146806 PMCID: PMC4699844 DOI: 10.1038/bmt.2015.149] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 04/27/2015] [Accepted: 05/20/2015] [Indexed: 12/22/2022]
Abstract
We describe 47 patients with lymphoma and failed prior autologous hematopoietic cell transplantation (HCT) who received TLI-ATG conditioning followed by allogeneic HCT. Thirty-two patients had non-Hodgkin lymphoma (NHL; diffuse large B cell lymphoma [n=19], T-cell NHL [n=6], mantle cell lymphoma [n= 4], or other B-cell subtypes [n=3]), and 15 had Hodgkin lymphoma. The median follow-up was 4.9 (range, 2.1–11.9) years. The cumulative incidence of grade II–IV acute GVHD at day +100 was 12%, and the cumulative incidence of extensive chronic GVHD at 1 year was 36%. The 3-year cumulative incidences of overall survival, progression-free survival (PFS), and non-relapse mortality (NRM) were 81%, 44%, and 7%, respectively. Fifteen patients died (relapse, n=10; NRM, n=5). Among the 25 patients with relapse after allogeneic HCT, 11 (44%) achieved durable (>1 year) complete remissions following donor lymphocyte infusion or chemoradiotherapy. The majority of surviving patients (75%; n=24) were able to discontinue all immunosuppression. For patients with relapsed lymphoma after autologous HCT, allogeneic HCT using TLI-ATG conditioning is a well-tolerated, predominantly outpatient therapy with low NRM (7% at 3 years), a low incidence of GVHD, durable disease control, and excellent overall survival (81% at 3 years).
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17
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Perales MA, Ceberio I, Armand P, Burns LJ, Chen R, Cole PD, Evens AM, Laport GG, Moskowitz CH, Popat U, Reddy NM, Shea TC, Vose JM, Schriber J, Savani BN, Carpenter PA. Role of cytotoxic therapy with hematopoietic cell transplantation in the treatment of Hodgkin lymphoma: guidelines from the American Society for Blood and Marrow Transplantation. Biol Blood Marrow Transplant 2015; 21:971-83. [PMID: 25773017 DOI: 10.1016/j.bbmt.2015.02.022] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 02/25/2015] [Indexed: 12/22/2022]
Abstract
The role of hematopoietic cell transplantation (HCT) in the therapy of Hodgkin lymphoma (HL) in pediatric and adult patients is reviewed and critically evaluated in this systematic evidence-based review. Specific criteria were used for searching the published literature and for grading the quality and strength of the evidence and the strength of the treatment recommendations. Treatment recommendations based on the evidence are included and were reached unanimously by a panel of HL experts. Both autologous and allogeneic HCT offer a survival benefit in selected patients with advanced or relapsed HL and are currently part of standard clinical care. Relapse remains a significant cause of failure after both transplant approaches, and strategies to decrease the risk of relapse remain an important area of investigation.
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Affiliation(s)
- Miguel-Angel Perales
- Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York.
| | - Izaskun Ceberio
- Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York; Hematology Department, Hospital Universitario Donostia, Donostia, Spain
| | - Philippe Armand
- Division of Hematological Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Linda J Burns
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Robert Chen
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, California
| | - Peter D Cole
- Department of Pediatrics, Albert Einstein College of Medicine and Department of Pediatric Hematology/Oncology, The Children's Hospital at Montefiore, Bronx, New York
| | - Andrew M Evens
- Department of Hematology/Oncology, Tufts Medical Center, Boston, Massachusetts
| | - Ginna G Laport
- Division of Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, California
| | - Craig H Moskowitz
- Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - Uday Popat
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nishitha M Reddy
- Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Thomas C Shea
- Division of Hematology/Oncology, University of North Carolina, Chapel Hill, North Carolina
| | - Julie M Vose
- Division of Hematology/Oncology, The Nebraska Medical Center, Omaha, Nebraska
| | - Jeffrey Schriber
- Cancer Transplant Institute, Virginia G Piper Cancer Center, Scottsdale, Arizona
| | - Bipin N Savani
- Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Paul A Carpenter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
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Sureda A, Domenech E, Schmitz N, Dreger P. The role of allogeneic stem cell transplantation in Hodgkin's lymphoma. Curr Treat Options Oncol 2015; 15:238-47. [PMID: 24752768 DOI: 10.1007/s11864-014-0287-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OPINION STATEMENT The treatment of patients with classical Hodgkin's lymphoma relapsing after autologous stem cell transplantation represents a clear unmet need. Overall long-term outcome is not the same in these patients and therapeutic options in this setting are very heterogeneous and include salvage CT and/or RT followed or not by a second stem cell transplantation, palliative care, new drugs, or biological agents. Despite the absence of prospective, randomized, clinical trials, allogeneic stem cell transplantation either from a HLA identical sibling or a matched, unrelated donor represents an attractive option for those young patients with chemosensitive disease after being treated with a salvage protocol. The use of reduced intensity conditioning regimens has been able to drastically decrease nonrelapse mortality, although relapse rate remains a significant issue in this setting. More intense conditioning protocols could eventually decrease the relapse rate after the allogeneic procedure and, as indicated by a recent retrospective analysis of the Lymphoma Working Party of the European Group for Blood and Marrow Transplantation, nonrelapse mortality does not represent a major problem nowadays for patients with multiply relapsed Hodgkin's lymphoma. Brentuximab vedotin is an antibody-drug conjugate that selectively delivers monomethyl auristatin E, an antimicrotubule agent, into CD30-expressing cells. Its use has been approved recently for patients with Hodgkin's lymphoma relapsing after autologous stem cell transplantation. As a single dose, brentuximab vedotin is able to achieve an objective response rate of 75 % with 34 % of the patients achieving a complete remission. Its widespread use will most certainly change the treatment paradigm of this subgroup of patients, either avoiding the allogeneic procedure in some patients or by increasing the group of potential candidates to an allogeneic transplant being used as a "bridge to allo." Additional information on long-term outcome of patients being treated with this drug or the development of prospective clinical trials in this setting will most probably give some light to this question we have nowadays.
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Affiliation(s)
- Anna Sureda
- Hematology Department, Institut Català d'Oncologia - Hospital Duran I Reynals, Avda. Gran Via, 199 - 203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain,
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Bonthapally V, Yang H, Ayyagari R, Tan RD, Cai S, Wu E, Gautam A, Chi A, Huebner D. Brentuximab vedotin compared with other therapies in relapsed/refractory Hodgkin lymphoma post autologous stem cell transplant: median overall survival meta-analysis. Curr Med Res Opin 2015; 31:1377-89. [PMID: 25950500 DOI: 10.1185/03007995.2015.1048208] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This meta-analysis compared the median overall survival (mOS) of brentuximab vedotin reported in the pivotal phase 2 study with published results of other therapies for the treatment of relapsed/refractory (R/R) Hodgkin lymphoma (HL) post autologous stem cell transplant (ASCT). RESEARCH DESIGN AND METHODS A systematic literature review identified studies that reported survival outcomes following conventional/experimental therapies in R/R HL patients, with ≥50% having failed ≥1 ASCT. Kaplan-Meier curves were used to reconstruct individual patient level survival data. Patients were grouped by treatment type and reconstructed data were used to estimate the mOS. Censored median regression modeling was used to compare mOS in each group with the mOS in the pivotal brentuximab vedotin trial. All patients in the pivotal trial had undergone ASCT, therefore a sensitivity analysis was conducted among studies with a 100% post-ASCT patient population. RESULTS The mOS reported for brentuximab vedotin was 40.5 (95% CI 30.8-NA) compared with 26.4 months (95% CI 23.5-28.5) across all 40 studies identified (n = 2518 excluding the brentuximab vedotin trial) (p < 0.0001). The difference in mOS between brentuximab vedotin and chemotherapy, allogeneic stem cell transplant (allo-SCT), and other therapies, was 17.7 (95% CI 10.6-24.7; p < 0.0001), 12.5 (95% CI 8.2-16.9; p < 0.0001), and 15.2 months (95% CI 4.9-25.5; p = 0.0037), respectively. For the 11 studies reporting a 100% prior-ASCT rate (n = 662 excluding the brentuximab vedotin trial), the mOS was 28.1 months (95% CI 23.9-34.5), and the difference in mOS between brentuximab vedotin, chemotherapy, allo-SCT, and other therapies was 19.0 (95% CI 12.9-25.1; p < 0.0001), 9.4 (p > 0.05), and 6.8 months (95% CI 1.2-12.5; p = 0.0018), respectively. CONCLUSIONS While some selection bias may occur when comparing trials with heterogeneous eligibility criteria, in the absence of randomized controlled trial data these results suggest brentuximab vedotin improves long-term survival and is associated with longer mOS in R/R HL post-ASCT compared with other therapies.
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Affiliation(s)
- Vijayveer Bonthapally
- Global Oncology Pricing Market Access and Health Economics, Millennium Pharmaceuticals Inc. , Cambridge, MA , USA , a wholly owned subsidiary of Takeda Pharmaceutical Company Limited
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Abstract
Patients with Hodgkin lymphoma (HL) who relapse following effective front-line therapy are offered salvage second-line chemotherapy regimens followed by high-dose therapy and autologous stem cell transplantation (HDT/ASCT). Randomized studies comparing HDT/ASCT with conventional chemotherapy in patients with relapsed refractory HL have shown significant improvement in progression-free survival and freedom from treatment failure but were not powered to show improvements in overall survival. For patients who relapse after salvage HDT/ASCT, novel therapies exist as a bridge to allogeneic SCT. In this article, we review indications and results of autologous and allogeneic SCT in HL.
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Affiliation(s)
- Nishitha M Reddy
- Division of Hematology/Oncology, Vanderbilt University Medical Center, 3927 The Vanderbilt Clinic, Vanderbilt-Ingram Cancer Center, Nashville, TN 37232, USA
| | - Miguel-Angel Perales
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Box 298, New York, NY 10065, USA.
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Dozzo M, Battista ML, Medeot M, Sperotto A, Fanin R, Patriarca F. Long lasting remission after haploidentical stem cell transplant and pre-emptive donor lymphocyte infusions in a patient with primary refractory Hodgkin lymphoma. Leuk Lymphoma 2014; 56:1129-31. [PMID: 25058370 DOI: 10.3109/10428194.2014.946024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Massimo Dozzo
- Department of Hematology, Stem Cell Transplant Unit, DISM, University Hospital , Udine , Italy
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22
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Sauter CS, Chou JF, Papadopoulos EB, Perales MA, Jakubowski AA, Young JW, Scordo M, Giralt S, Castro-Malaspina H. A prospective study of an alemtuzumab containing reduced-intensity allogeneic stem cell transplant program in patients with poor-risk and advanced lymphoid malignancies. Leuk Lymphoma 2014; 55:2739-47. [PMID: 24528216 DOI: 10.3109/10428194.2014.894185] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Reduced-intensity conditioning (RIC) regimens for allogeneic stem cell transplant (allo-SCT) have used alemtuzumab to abrogate the risk of graft-versus-host disease (GVHD). Thirty-eight patients with advanced lymphoma underwent a prospective phase II study of melphalan, fludarabine and alemtuzumab containing RIC allo-SCT from 20 matched related and 18 unrelated donors with cyclosporine-A as GVHD prophylaxis. The cumulative incidence of grade II-IV acute GVHD at 3 months was 10.5% and three evaluable patients experienced chronic GVHD. Progression-free (PFS) and overall (OS) survival at 5 years was 25% (95% confidence interval [CI]: 13-40%) and 44% (95% CI: 28-59%), respectively. Previous high-dose therapy and autologous stem cell transplant (HDT-ASCT) and elevated lactate dehydrogenase (LDH) at the time of allo-SCT resulted in inferior OS. Within this cohort of patients with high-risk lymphoma, alemtuzumab containing RIC resulted in a low risk of GVHD and a high incidence of progression of disease, especially in those with poor-risk features defined by elevated LDH pre-allo-SCT and previous HDT-ASCT.
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Affiliation(s)
- Craig S Sauter
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center , New York, NY , USA
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24
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Messer M, Steinzen A, Vervölgyi E, Lerch C, Richter B, Dreger P, Herrmann-Frank A. Unrelated and alternative donor allogeneic stem cell transplant in patients with relapsed or refractory Hodgkin lymphoma: a systematic review. Leuk Lymphoma 2013; 55:296-306. [PMID: 23656201 DOI: 10.3109/10428194.2013.802780] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract Allogeneic stem cell transplant (allo-SCT) is considered a clinical option for patients with Hodgkin lymphoma (HL) who have experienced at least two chemosensitive relapses. The aim of this systematic review was to determine the benefits and harms of allo-SCT with an unrelated donor (UD) versus related donor (RD) allo-SCT for adult patients with HL. Alternative donor sources such as haploidentical donor cells (Haplo) and umbilical cord blood (UCB) were also included. The available evidence was limited. Ten studies were included in this assessment. Four studies provided sufficient data to compare UD with RD allo-SCT. None of these studies was a randomized controlled trial. Additionally, three non-comparative studies, such as registry analyses, which considered patients with UD transplants were included. The risk of bias in the studies was high. Results on overall and progression-free survival (PFS) showed no consistent tendency in favor of a donor type. Results on therapy-associated mortality and acute (grade II-IV) and chronic graft-versus-host disease were also inconsistent. The study comparing UCB with RD transplants and two non-comparative studies with UCB transplants showed similar results. One of the studies comparing additionally Haplo with RD transplants indicated a benefit in PFS for the Haplo transplant group. In summary, our findings do not indicate a substantial outcome disadvantage of UD and alternative donor sources versus RD allo-SCT for adult patients with advanced HL.
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Affiliation(s)
- Melanie Messer
- Institute for Quality and Efficiency in Health Care , Cologne , Germany
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25
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Moscato T, Fedele R, Messina G, Irrera G, Console G, Martino M. Hematopoietic progenitor cells transplantation for recurrent or refractory Hodgkin's lymphoma. Expert Opin Biol Ther 2013; 13:1013-27. [PMID: 23586758 DOI: 10.1517/14712598.2013.779250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Advanced-stage Hodgkin's lymphoma (HL) has become a curable disease in the majority of patients. Despite this, about 20% of these patients relapsed or are primary refractory to the first-line treatment and high-dose chemotherapy (HDC) and autologous (Auto) hematopoietic progenitor cells transplantation (HPCT) are considered a therapeutic option. AREAS COVERED The authors reviewed HDC and HPCT treatment strategies in recurrent or refractory HL patients, with the goal of providing an overview of this approach. EXPERT OPINION Patients younger than 60-65 years with relapsed disease or refractory to first-line therapy should receive a second-line chemotherapy, followed by HDC and Auto-HPCT. Progression-free and overall survival results are significantly better when a second remission or a minimal disease status is achieved before Auto-HPCT, and demonstrate that this strategy is able to cure more than half of the advanced HL patients. Myeloablative allogeneic HPCT (Allo-HPCT) has been employed in advanced phases of the disease, but there have been significant concerns due to treatment-related mortality (TRM). The safety of allogeneic transplantation has improved with the use of reduced-intensity allogeneic (RIC-Allo) HPCT strategies. Despite early favorable results, mature results of RIC-Allo available in the literature are consistent in demonstrating a lack of long-term disease control.
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Affiliation(s)
- Tiziana Moscato
- Hematology and Bone Marrow Transplant Unit, Azienda Ospedaliera BMM, Via Melacrino n.1, 89100 Reggio Calabria, Italy.
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Indications and outcomes of reduced-toxicity hematopoietic stem cell transplantation in adult patients with hematological malignancies. Int J Hematol 2013; 97:581-98. [PMID: 23585244 DOI: 10.1007/s12185-013-1313-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 03/12/2013] [Accepted: 03/12/2013] [Indexed: 02/05/2023]
Abstract
Hematopoietic stem cell transplantation (HCT) utilizing non-myeloablative (NMA) and reduced-intensity conditioning (RIC) regimens (collectively referred to as reduced-toxicity HCT, RT-HCT) has become a viable therapeutic option for patients with hematological malignancies who are ineligible for standard myeloablative conditioning transplantation (MA-HCT). RT-HCT has been shown to induce stable engraftment with low toxicity, and to produce similar overall and progression-free survival (PFS) when compared to MA-HCT in acute myeloid leukemia and myelodysplastic syndrome. The best results for RT-HCT have been reported for patients with disease that is in remission, indolent and chemosensitive, and with a strong graft-versus-malignancy effect. Chronic graft-versus-host disease seems to correlate with a lower relapse rate and better PFS. RT-HCT is inferior when performed in poor risk or advanced disease, due to high relapse rates. A search for novel strategies that includes the most appropriate conditioning regimens and post-transplant immunomodulation protocols with more intensive anti-malignancy activity but limited toxicity is in progress. This review provides an update on the results of clinical studies of RT-HCT, and discusses possible indications and investigative strategies for improving the clinical outcomes of RT-HCT for the major hematological malignancies.
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The role of hematopoietic stem cell transplantation in the treatment of relapsed/refractory Hodgkin's lymphoma. Curr Opin Oncol 2013; 24:727-32. [PMID: 23079783 DOI: 10.1097/cco.0b013e328359557e] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Autologous stem cell transplantation (ASCT) represents the treatment of choice for primary refractory or relapsed Hodgkin's lymphoma patients. Nevertheless, the results of ASCT are not universally uniform in all groups of patients. Allogeneic stem cell transplantation (allo-SCT) has increasingly been used to rescue failures after an ASCT. Its use is going to be potentially challenged by the advent of targeted therapy. RECENT FINDINGS Comprehensive information regarding prognostic factors in the ASCT setting that can allow to discriminate specific groups potentially candidates for other therapies is presented as well as an updated summary of the potential role of reduced intensity allo-SCT in relapsed patients including the largest phase II prospective clinical trial. Outcome of multiply relapsed Hodgkin's lymphoma patients treated with single-dose brentuximab vedotin, a new anti-CD30 monoclonal antibody, is discussed. SUMMARY ASCT results might well be implemented by improving the quality of the remission of patients undergoing the procedure with more effective salvage protocols or by selecting those patients who might better benefit from the procedure. Results of allo-SCT as well as the percentage of patients potentially candidates for the procedure will also be able to be modified with a better selection of the patients and the use of targeted and less toxic therapy to render patients into an adequate response.
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Gobbi PG, Ferreri AJ, Ponzoni M, Levis A. Hodgkin lymphoma. Crit Rev Oncol Hematol 2013; 85:216-37. [DOI: 10.1016/j.critrevonc.2012.07.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 03/02/2012] [Accepted: 07/03/2012] [Indexed: 10/28/2022] Open
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Role of hematopoietic stem cell transplantation in relapsed/refractory hodgkin lymphoma. Mediterr J Hematol Infect Dis 2012; 4:e2012059. [PMID: 23170188 PMCID: PMC3499990 DOI: 10.4084/mjhid.2012.059] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 09/21/2012] [Indexed: 11/09/2022] Open
Abstract
Hodgkin lymphoma is one of the most curable human tumors. Despite this, about 30% of these patients relapsed or are primary refractory to the first line treatment. Autografting is generally considered the standard of care for these patients. Alternative salvage strategies have been evaluated such as high dose sequential and tandem autografting strategies. In younger patients, refractory or early relapsed after autografting, allogeneic stem cell transplantation has been employed but this approach has been followed by significant concerns since the treatment related mortality, often exceeded 40–50%, and relapses were not uncommon. It is clear that patient selection remains an issue in all allografting reports. At the end, new drugs and novel treatment strategies, that are based on our understanding of the disease biology and signaling pathways, are needed to improve treatment outcome for these patients. The two leading compounds Brentuximab Vedotin and Panobinostat, are currently under evaluation in several clinical trials.
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Currin ESR, Gopal AK. Treatment strategies for Hodgkin lymphoma recurring following autologous hematopoietic stem cell transplantation. THE KOREAN JOURNAL OF HEMATOLOGY 2012; 47:8-16. [PMID: 22479273 PMCID: PMC3317478 DOI: 10.5045/kjh.2012.47.1.8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Accepted: 03/20/2012] [Indexed: 11/17/2022]
Abstract
Hodgkin lymphoma (HL) represents one of the great success stories in hematology going from a uniformly fatal disease, to one that is curable in the vast majority of cases. Despite this success, some patients experience relapse. To address this unmet need a variety of agents, classes of drugs, and strategies have demonstrated activity in HL recurring after autologous hematopoietic stem cell transplantation. These include chemotherapeutics (gemcitabine-based combinations, bendamustine), histone deacetylase (HDAC) inhibitors (panobinostat), immunomodulatory agents (lenalidomide), mTOR inhiobitors (everolimus), monoclonal antibodies (rituximab), and antibody-drug conjugates (brentuximab vedotin) as well the potential of long-term disease control via allogeneic transplantation. Such advances reflect our increased understanding of the biology of HL and hold promise for continued improved outcomes for those suffering with this condition.
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Affiliation(s)
- Erin-Siobhain R Currin
- Department of Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA
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31
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Moore S, Kayani I, Peggs K, Qian W, Lowry L, Thomson K, Linch DC, Ardeshna K. Mini-BEAM is effective as a bridge to transplantation in patients with refractory or relapsed Hodgkin lymphoma who have failed to respond to previous lines of salvage chemotherapy but not in patients with salvage-refractory DLBCL. Br J Haematol 2012; 157:543-52. [PMID: 22429186 DOI: 10.1111/j.1365-2141.2012.09096.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 01/16/2012] [Indexed: 12/01/2022]
Abstract
Patients with relapsed or refractory lymphoma can be cured with stem cell transplantation if they are shown to have disease that is responsive to salvage chemotherapy. Patients who fail to respond to first-line salvage chemotherapy tend to do very poorly. Here we report on 39 such patients who received mini-BEAM (carmustine, etoposide, cytarabine, melphalan) chemotherapy as second or subsequent-line salvage chemotherapy. Fifty-six percent of these patients had primary refractory disease and a further 28% had responses to first-line therapy that lasted <12 months. Seventy-two percent had progressive disease following the salvage chemotherapy administered immediately prior to mini-BEAM and the remaining 28% had stable disease. Overall there was a 38% response to mini-BEAM (complete response = 28%, partial response = 10%). Patients with Hodgkin lymphoma (HL) had a higher response rate compared to those with diffuse large B cell lymphoma (DLBCL) (63% vs. 20%). Seventy-four percent of HL patients were able to proceed to transplantation compared with 30% of patients with DLBCL. Mini-BEAM is a very effective bridge to transplantation in very poor risk patients with HL who have failed to respond to first-line salvage chemotherapy. Its efficacy in non-Hodgkin lymphoma is more modest.
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Affiliation(s)
- Sally Moore
- Department of Haematology, University College Hospital, London, UK.
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32
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Villa D, Seshadri T, Puig N, Massey C, Tsang R, Keating A, Crump M, Kuruvilla J. Second-line salvage chemotherapy for transplant-eligible patients with Hodgkin's lymphoma resistant to platinum-containing first-line salvage chemotherapy. Haematologica 2011; 97:751-7. [PMID: 22180434 DOI: 10.3324/haematol.2011.047670] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The management of patients with relapsed or refractory Hodgkin's lymphoma who achieve less than a partial response to first-line salvage chemotherapy is unclear. The objective of this study was to evaluate response and outcomes to second-line salvage and autologous stem cell transplantation in patients not achieving a complete or partial response to platinum-containing first-line salvage chemotherapy. DESIGN AND METHODS Consecutively referred transplant-eligible patients with relapsed/refractory Hodgkin's lymphoma after primary chemotherapy received gemcitabine, dexamethasone, and cisplatin as first salvage chemotherapy. Those achieving a complete or partial response, and those with a negative gallium scan and stable disease with bulk <5 cm proceeded to high-dose chemotherapy and autologous stem cell transplantation. Patients with progressive disease or stable disease with a positive gallium scan or bulk ≥ 5 cm were given second salvage chemotherapy with mini-BEAM (carmustine, etoposide, cytarabine, melphalan). Patients who responded (according to the same definition) proceeded to autologous stem cell transplantation. RESULTS One hundred and thirty-one patients with relapsed/refractory Hodgkin's lymphoma received first-line salvage gemcitabine, dexamethasone, and cisplatin; of these patients 99 had at least a partial response (overall response rate 76%). One hundred and twelve (85.5%) patients proceeded to autologous stem cell transplantation, while the remaining 19 (14.5%) patients received mini-BEAM. Among these 19 patients, six had at least a partial response (overall response rate 32%), and nine proceeded to autologous stem cell transplantation. The remaining ten patients received palliative care. Seven of the nine patients transplanted after mini-BEAM had a subsequent relapse. Patients receiving second salvage mini-BEAM had poor outcomes, with a 5-year progression-free survival rate of 11% and a 5-year overall survival rate of 20%. CONCLUSIONS Patients who require a second salvage regimen to achieve disease control prior to autologous stem cell transplantation have a relatively poor outcome and should be considered for alternative treatment strategies.
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Affiliation(s)
- Diego Villa
- Autologous Blood and Marrow Transplant Program, Princess Margaret Hospital, Toronto, ON, Canada
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Jantunen E, Sureda A. The evolving role of stem cell transplants in lymphomas. Biol Blood Marrow Transplant 2011; 18:660-73. [PMID: 21963876 DOI: 10.1016/j.bbmt.2011.09.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 09/10/2011] [Indexed: 10/17/2022]
Abstract
Autologous stem cell transplantation (ASCT) is an established therapeutic modality in the treatment of lymphomas, especially in the relapse setting. It is also under investigation after first-line therapy, for example, in patients with mantle cell or T cell lymphomas. Each year more than 6000 autotransplants for lymphomas are reported to the European Blood and Marrow Transplantation (EBMT) registry. The number of allogeneic stem cell transplantations (alloSCT) in lymphoma patients has increased over the last decade, with about 1200 transplanted lymphoma patients annually reported to the registry. Optimal timing and indications for alloSCT are not well defined because of absence of randomized trials. Developments in the treatment of lymphomas including immunotherapy have changed the clinical scenarios in regard to ASCT, and many published studies are now outdated. On the other hand, patients relapsing after immunochemotherapy may derive less benefit from ASCT. Consequently, there is an increasing interest in using alloSCT not only in lymphoma patients relapsing after ASCT but also in earlier phases in specific circumstances. Although curative potential is higher with alloSCT compared with ASCT, its wider use has been hindered by excessive nonrelapse mortality (NRM). Along with decreasing NRM figures, popularity of alloSCT may increase in the near future, possibly with the expense of ASCT. Prospective, randomized studies are needed to evaluate feasibility and efficacy of alloSCT in several clinical settings, as most published evidence is based on retrospective registry data or single-center experiences.
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Affiliation(s)
- Esa Jantunen
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
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Arantes ADM, Teixeira FS, Ribaie TMA, Duartec LL, Silva CRA, Bariani C. Autologous stem-cell transplantation in Hodgkin's lymphoma: analysis of a therapeutic option. EINSTEIN-SAO PAULO 2011; 9:124-9. [PMID: 26760803 DOI: 10.1590/s1679-45082011ao1847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To report the clinical progress of patients with Hodgkin's lymphoma treated with autologous transplantation after failure or relapse of first-line treatment with chemotherapy and/or radiation therapy. METHODS The results of a retrospective analysis of 31 patients submitted to autologous transplantation as second-line treatment, between April 2000 and December 2008, were analyzed. Fourteen men and seventeen women, with a median age of 27 years, were submitted to autologous transplantation for relapsed (n = 21) or refractory (n = 10) Hodgkin's lymphoma. RESULTS Mortality related to treatment in the first 100 days after transplant was 3.2%. With a mean follow-up period of 18 months (range: 1 to 88 months), the probability of global survival and progression-free survival in 18 months was 84 and 80%, respectively. The probability of global survival and progression-free survival at 18 months for patients with chemosensitive relapses (n = 21) was 95 and 90%, respectively, versus 60 and 45% for patients with relapses resistant to chemotherapy (n = 10) (p = 0.001 for global survival; p = 0.003 for progression-free survival). In the multivariate analysis, absence of disease or pretransplant disease < 5 cm were favorable factors for global survival (p= 0.02; RR: 0.072; 95%CI: 0.01-0.85) and progression-free survival (p= 0.01; RR: 0.040; 95%CI: 0.007-0.78). CONCLUSION Autologous transplantation of stem-cells is a therapeutic option for Hodgkin's lymphoma patients after the first relapse. Promising results were observed in patients with a low tumor burden at transplant.
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Affiliation(s)
| | | | | | - Luciana Lobo Duartec
- Bone Marrow Transplantation Service, Hospital Araújo Jorge - HAJ, Goiânia, GO, BR
| | | | - César Bariani
- Bone Marrow Transplantation Service, Hospital Araújo Jorge - HAJ, Goiânia, GO, BR
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Eichenauer DA, Fuchs M, Borchmann P, Engert A. Hodgkin's lymphoma: current treatment strategies and novel approaches. Expert Rev Hematol 2011; 1:63-73. [PMID: 21083007 DOI: 10.1586/17474086.1.1.63] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Approximately 80% of Hodgkin's lymphoma (HL) patients achieve long-term remission after primary chemotherapy or chemo/radiotherapy. Despite these excellent results, further treatment improvement is necessary. HL therapy is associated with severe acute and long-term toxicities. Thus, a major aim of clinical HL research is to evaluate novel schemes that are less toxic than current standard regimens without being less effective. Another focus is the treatment of patients with multiple relapses. Standard treatment for these patients has not yet been defined, and their prognosis is still poor. Reduced-intensity conditioning allogeneic stem cell transplantation was recently shown to be effective in carefully selected young chemosensitive patients. Furthermore, new strategies such as antibody- and small-molecule-based therapy have demonstrated encouraging results in preclinical studies and the first clinical trials.
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Affiliation(s)
- Dennis A Eichenauer
- First Department of Internal Medicine, University Hospital of Cologne, Kerpener Str. 62, 50924 Cologne, Germany.
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Peggs KS, Kayani I, Edwards N, Kottaridis P, Goldstone AH, Linch DC, Hough R, Morris EC, Fielding A, Chakraverty R, Thomson KJ, Mackinnon S. Donor Lymphocyte Infusions Modulate Relapse Risk in Mixed Chimeras and Induce Durable Salvage in Relapsed Patients After T-Cell–Depleted Allogeneic Transplantation for Hodgkin's Lymphoma. J Clin Oncol 2011; 29:971-8. [DOI: 10.1200/jco.2010.32.1711] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Purpose Reduced-intensity conditioning has minimized nonrelapse-related mortality rates after allogeneic transplantation in patients with Hodgkin's lymphoma, and relapse has now become the major cause for treatment failure. We aimed to assess the impact of donor lymphocyte infusions (DLIs) on relapse incidence when administered for mixed chimerism and their utility as salvage therapy when given for relapse. Patients and Methods This study reports the outcomes of 76 consecutive patients with multiply relapsed or refractory Hodgkin's lymphoma who underwent allogeneic transplantation that incorporated in vivo T-cell depletion. Forty-two patients had related donors and 34 had unrelated donors. DLIs were administered in a dose-escalating fashion to 22 patients for mixed chimerism (median time of first dose, 9 months post-transplantation) and to 24 patients for relapse. Results Three-year donor lymphocyte–related mortality was 7%, relating mainly to the induction of graft-versus-host disease. Nineteen (86%) of 22 patients receiving donor lymphocytes for mixed chimerism converted to full donor status. Four-year relapse incidence was 5% in these 22 patients compared with 43% in patients who remained relapse free but full donor chimeras at 9 months post-transplantation (P = .0071). Nineteen (79%) of 24 patients receiving donor lymphocytes for relapse responded (14 complete responses, five partial responses). Four-year overall survival from relapse was 59% in recipients of donor lymphocytes, contributing to a 4-year overall survival from transplantation of 64% and a 4-year current progression-free survival of 59% in all 76 patients. Conclusion These data demonstrate the potential for allogeneic immunotherapy with donor lymphocytes both to reduce relapse risk and to induce durable antitumor responses in patients with Hodgkin's lymphoma after hematopoietic stem-cell transplantation that incorporates in vivo T-cell depletion.
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Affiliation(s)
- Karl S. Peggs
- From the University College London Cancer Institute, University College London Hospitals National Health Service Foundation Trust, and Royal Free Hospital, London, United Kingdom
| | - Irfan Kayani
- From the University College London Cancer Institute, University College London Hospitals National Health Service Foundation Trust, and Royal Free Hospital, London, United Kingdom
| | - Noha Edwards
- From the University College London Cancer Institute, University College London Hospitals National Health Service Foundation Trust, and Royal Free Hospital, London, United Kingdom
| | - Panagiotis Kottaridis
- From the University College London Cancer Institute, University College London Hospitals National Health Service Foundation Trust, and Royal Free Hospital, London, United Kingdom
| | - Anthony H. Goldstone
- From the University College London Cancer Institute, University College London Hospitals National Health Service Foundation Trust, and Royal Free Hospital, London, United Kingdom
| | - David C. Linch
- From the University College London Cancer Institute, University College London Hospitals National Health Service Foundation Trust, and Royal Free Hospital, London, United Kingdom
| | - Rachael Hough
- From the University College London Cancer Institute, University College London Hospitals National Health Service Foundation Trust, and Royal Free Hospital, London, United Kingdom
| | - Emma C. Morris
- From the University College London Cancer Institute, University College London Hospitals National Health Service Foundation Trust, and Royal Free Hospital, London, United Kingdom
| | - Adele Fielding
- From the University College London Cancer Institute, University College London Hospitals National Health Service Foundation Trust, and Royal Free Hospital, London, United Kingdom
| | - Ronjon Chakraverty
- From the University College London Cancer Institute, University College London Hospitals National Health Service Foundation Trust, and Royal Free Hospital, London, United Kingdom
| | - Kirsty J. Thomson
- From the University College London Cancer Institute, University College London Hospitals National Health Service Foundation Trust, and Royal Free Hospital, London, United Kingdom
| | - Stephen Mackinnon
- From the University College London Cancer Institute, University College London Hospitals National Health Service Foundation Trust, and Royal Free Hospital, London, United Kingdom
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37
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Carbone A, Spina M, Gloghini A, Tirelli U. Classical Hodgkin's lymphoma arising in different host's conditions: pathobiology parameters, therapeutic options, and outcome. Am J Hematol 2011; 86:170-9. [PMID: 21264899 DOI: 10.1002/ajh.21910] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Epidemiologic and molecular findings suggest that classical Hodgkin's lymphoma (CHL) is not a single disease but consists of more than one entity and may occur in different clinical settings. This review analyzes similarities and disparities among CHL entities arising in different host's conditions with respect to pathobiology parameters, therapeutic options, and outcome. For the purpose of this analysis, CHL entities have been subdivided according to the immune status of the host. In nonimmunosuppressed hosts, according to the age, CHL include pediatric, adult, and elderly forms, whereas, in immunosuppressed hosts, according to the type of immunosuppression, CHL include human immunodeficiency virus (HIV)-associated, iatrogenic, and post-transplant types. CHL entities in different settings are similar in morphology of neoplastic cells, expression of activation markers, and aberrations/activation of NFKB, JAK/STAT, and P13K/AKT pathways, but differ in the association with Epstein-Barr virus (EBV) infection, persistent B-cell phenotype, and cellular background composition. Large B-cell lymphomas resembling CHL may also be observed in the same clinical settings. These lesions, however, do not fulfill the diagnostic criteria of CHL and clinically display a very aggressive behavior. In this article, current treatment options for the CHL entities, especially for elderly CHL and HIV-associated CHL, are specifically reviewed. ABVD remains the gold standard both in nonimmunosuppressed or immunosuppressed hosts even if there are several data suggesting a possible improvement in outcome using the aggressive BEACOPP regimen in advanced stages. Refractory CHL, a clinical condition that may occur throughout the entire spectrum of CHL, is discussed separately.
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Affiliation(s)
- Antonino Carbone
- Division of Pathology, Centro di Riferimento Oncologico Aviano, Istituto Nazionale Tumori, Aviano, Italy
| | - Michele Spina
- Department of Medical Oncology, Centro di Riferimento Oncologico Aviano, Istituto Nazionale Tumori, Aviano, Italy
| | - Annunziata Gloghini
- Department of Diagnostic Pathology and Laboratory Medicine, Istituto Nazionale Tumori, Milano, Italy
| | - Umberto Tirelli
- Department of Medical Oncology, Centro di Riferimento Oncologico Aviano, Istituto Nazionale Tumori, Aviano, Italy
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Allogeneic hematopoietic stem cell transplantation: does it have a place in treating Hodgkin lymphoma? Curr Hematol Malig Rep 2011; 5:229-38. [PMID: 20730513 DOI: 10.1007/s11899-010-0065-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Although the majority of patients with Hodgkin lymphoma achieve sustained remission with frontline treatment, there is still a subset of patients with much less favorable prognosis. The current standard of care for Hodgkin lymphoma patients with relapsed or refractory disease is autologous stem cell transplantation. However, no randomized trial has compared autologous stem cell transplantation with allogeneic stem cell transplantation prospectively, and most studies comparing allogeneic stem cell transplantation with historical controls of autologous stem cell transplantation use a myeloablative conditioning reference group. With the more frequent use of reduced-intensity conditioning transplantation in recent studies, the role for allogeneic stem cell transplantation in Hodgkin lymphoma patients is being redefined. In contrast to other types of lymphomas, Hodgkin lymphoma patients are younger at diagnosis, which makes a curative strategy such as allogeneic stem cell transplantation particularly appealing. This review examines the role of allogeneic stem cell transplantation in Hodgkin lymphoma by looking at both retrospective and prospective analyses in the era of reduced-intensity conditioning transplantation, donor lymphocyte infusions, and biologically based treatments.
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Cremer B, Sandmaier BM, Bethge W, Lange T, Goede V, Holtick U, Hallek M, Hübel K. Reduced-Intensity Conditioning in Allogeneic Stem Cell Transplantation for Hematological Malignancies: A Historical Perspective. ACTA ACUST UNITED AC 2011; 34:710-5. [DOI: 10.1159/000334542] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Porter DL, Alyea EP, Antin JH, DeLima M, Estey E, Falkenburg JHF, Hardy N, Kroeger N, Leis J, Levine J, Maloney DG, Peggs K, Rowe JM, Wayne AS, Giralt S, Bishop MR, van Besien K. NCI First International Workshop on the Biology, Prevention, and Treatment of Relapse after Allogeneic Hematopoietic Stem Cell Transplantation: Report from the Committee on Treatment of Relapse after Allogeneic Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2010; 16:1467-503. [PMID: 20699125 PMCID: PMC2955517 DOI: 10.1016/j.bbmt.2010.08.001] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 08/03/2010] [Indexed: 12/31/2022]
Abstract
Relapse is a major cause of treatment failure after allogeneic hematopoietic stem cell transplantation (alloHSCT). Treatment options for relapse have been inadequate, and the majority of patients ultimately die of their disease. There is no standard approach to treating relapse after alloHSCT. Withdrawal of immune suppression and donor lymphocyte infusions are commonly used for all diseases; although these interventions are remarkably effective for relapsed chronic myelogenous leukemia, they have limited efficacy in other hematologic malignancies. Conventional and novel chemotherapy, monoclonal antibody therapy, targeted therapies, and second transplants have been utilized in a variety of relapsed diseases, but reports on these therapies are generally anecdotal and retrospective. As such, there is an immediate need for well-designed, disease-specific trials for treatment of relapse after alloHSCT. This report summarizes current treatment options under investigation for relapse after alloHSCT in a disease-specific manner. In addition, recommendations are provided for specific areas of research necessary in the treatment of relapse after alloHSCT.
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MESH Headings
- Hematologic Neoplasms/therapy
- Hematopoietic Stem Cell Transplantation
- Hodgkin Disease/therapy
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Leukemia, Myeloid, Acute/therapy
- Lymphocyte Transfusion
- Lymphoma, Non-Hodgkin
- Multiple Myeloma/therapy
- Neoplasm Recurrence, Local/therapy
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy
- Recurrence
- Transplantation, Homologous
- Treatment Failure
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Affiliation(s)
- David L Porter
- University of Pennsylvania Medical Center, Philadelphia, 19104, USA.
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41
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Klyuchnikov E, Bacher U, Kröger N, Kazantsev I, Zabelina T, Ayuk F, Zander AR. The Role of Allogeneic Stem Cell Transplantation in Relapsed/Refractory Hodgkin's Lymphoma Patients. Adv Hematol 2010; 2011:974658. [PMID: 20981158 PMCID: PMC2964008 DOI: 10.1155/2011/974658] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Accepted: 09/17/2010] [Indexed: 11/17/2022] Open
Abstract
Despite the favorable prognosis of most patients with Hodgkin's Lymphoma (HL), 15-20% of patients remain refractory to chemoradiotherapy, and 20-40% experience relapses following autologous stem cell transplantation (SCT) being used as salvage approach in this situation. Long-term survival of only 20% was reported for patients who failed this option. As some authors suggested the presence of a graft versus HL effect, allogeneic SCT was introduced as a further option. Myeloablative strategies were reported to be able to achieve cure in some younger patients, but high nonrelapse mortality remains a problem. Reduced intensity conditioning, in turn, was found to be associated with high posttransplant relapse rates. As there is currently no standard in the management of HL patients who failed autologous SCT, we here review the literature on allogeneic stem cell transplantation in HL patients with a special focus on the outcomes and risk factors being reported in the largest studies.
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Affiliation(s)
- Evgeny Klyuchnikov
- Interdisciplinary Clinic for Stem Cell Transplantation, University Cancer Center Hamburg (UCCH), Martinistr. 52, 20246 Hamburg, Germany
| | - Ulrike Bacher
- Interdisciplinary Clinic for Stem Cell Transplantation, University Cancer Center Hamburg (UCCH), Martinistr. 52, 20246 Hamburg, Germany
| | - Nicolaus Kröger
- Interdisciplinary Clinic for Stem Cell Transplantation, University Cancer Center Hamburg (UCCH), Martinistr. 52, 20246 Hamburg, Germany
| | - Ilya Kazantsev
- Interdisciplinary Clinic for Stem Cell Transplantation, University Cancer Center Hamburg (UCCH), Martinistr. 52, 20246 Hamburg, Germany
- Clinic for Stem Cell Transplantation, St. Petersburg State, Pavlov's Medical University, St. Petersburg 197022, Russia
| | - Tatjana Zabelina
- Interdisciplinary Clinic for Stem Cell Transplantation, University Cancer Center Hamburg (UCCH), Martinistr. 52, 20246 Hamburg, Germany
| | - Francis Ayuk
- Interdisciplinary Clinic for Stem Cell Transplantation, University Cancer Center Hamburg (UCCH), Martinistr. 52, 20246 Hamburg, Germany
| | - Axel Rolf Zander
- Interdisciplinary Clinic for Stem Cell Transplantation, University Cancer Center Hamburg (UCCH), Martinistr. 52, 20246 Hamburg, Germany
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Johansson JE, Remberger M, Lazarevic VL, Hallböök H, Wahlin A, Kimby E, Juliusson G, Omar H, Hägglund H. Allogeneic haematopoietic stem-cell transplantation with reduced intensity conditioning for advanced stage Hodgkin's lymphoma in Sweden: high incidence of post transplant lymphoproliferative disorder. Bone Marrow Transplant 2010; 46:870-5. [PMID: 20956959 DOI: 10.1038/bmt.2010.238] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Allogeneic transplantation after reduced intensity conditioning (allo-RIC) is a treatment option for patients with Hodgkin's lymphoma (HL) relapsing after autologous transplantation. In all, 23 adult patients with HL underwent allo-RIC in Sweden between 2000 and 2007. The median number of previous treatment lines was five and 20 patients (87%) were previously autografted. TRM at 100 days and at 1 year was 13 and 22% respectively. Acute GVHD grades II-IV developed in 7 out of 23 patients (30%) and chronic GVHD in 10 out of 20 patients at risk (50%). The OS and EFS at three years was 59 and 27%, respectively. Four patients (17%) developed post transplant lymphoproliferative disease (PTLD) after a median time of 55 days (range 38-95); two of these patients later died. The study confirmed that allo-RIC is feasible, but associated with a substantial relapse rate: only 20% of the patients were still alive 7 years after the transplant. A finding of high incidence of PTLD needs to be confirmed in a larger trial that includes patients with non-HL and CLL.
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Affiliation(s)
- J E Johansson
- Department of Hematology and Coagulation, Sahlgrenska University Hospital, Göteborg, Sweden.
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Li M, Gao C, Li H, Wang Z, Cao Y, Huang W, Li X, Wang S, Yu L, Da W. Allogeneic haematopoietic stem cell transplantation as a salvage strategy for relapsed or refractory nasal NK/T-cell lymphoma. Med Oncol 2010; 28:840-5. [DOI: 10.1007/s12032-010-9532-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Accepted: 04/07/2010] [Indexed: 10/19/2022]
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Nonmyeloablative and Reduced-Intensity Conditioning for Allogeneic Hematopoietic Stem Cell Transplantation. Am J Clin Oncol 2009; 32:618-28. [DOI: 10.1097/coc.0b013e31817f9de1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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45
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Deeg HJ. Transplantation conditioning regimens: can we say it better? Biol Blood Marrow Transplant 2009; 15:653-5. [PMID: 19450748 DOI: 10.1016/j.bbmt.2009.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Accepted: 03/10/2009] [Indexed: 10/20/2022]
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Second hematopoietic SCT for lymphoma patients who relapse after autotransplantation: another autograft or switch to allograft? Bone Marrow Transplant 2009; 44:559-69. [PMID: 19701250 DOI: 10.1038/bmt.2009.214] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Although autologous hematopoietic SCT (auto-HSCT) is the only potentially curative treatment for lymphoma that has relapsed after conventional chemotherapy, the prognosis of patients with disease recurrence after auto-HSCT is poor. Some highly selected patients can benefit from second transplants. One-third with late recurrence after initial auto-HSCT may attain a prolonged remission after second auto-HSCT. Non-myeloablative or reduced-intensity conditioning (RIC) allogeneic hematopoietic SCT (allo-HSCT) has been used successfully after auto-HSCT failures, especially in subjects who have an HLA-compatible donor, chemosensitive disease and good performance status. Patients with chemosenstive disease recurrence who have completed at least 1 year after their first auto-HSCT should be considered for a second auto-HSCT. Patients who have chemoresistant disease are best served by participation in a well-designed clinical trial examining novel antitumor agents.
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47
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[Autologous stem cell transplantation in the treatment of Hodgkin's disease]. VOJNOSANIT PREGL 2009; 66:571-6. [PMID: 19678583 DOI: 10.2298/vsp0907571t] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIM High-dose chemotherapy with autologous stem cell transplantation (ASCT) has shown to produce long-term disease-free survival in patients with chemotherapy-sensitive Hodgkin disease. The aim of the study was to evaluate efficacy of ASCT in the treatment of Hodgkin's disease. METHODS Between May 1997 and September 2008, 34 patients with Hodgkin's disease in median age of 25 (range 16-60) years, underwent ASCT. Autologous SCT were performed as consolidation therapy in one poor-risk patients with complete response (CR) and in 10 patients in partial remission (PR) after induction chemotherapy (32.5%), for chemosensitive relapse (CSR 1 and CSR 2) in 47% patients and in 20.5% patients with chemoresistant disease (CRD). All except one patient were in stage III/IV, extranodal site of disease had 24 patients and bulky disease had 10 patients. All the patients received a uniform preparatory regimen (BEAM). RESULTS An overall response was achieved in 30 of 32 evaluated patients, with 62.5% in CR and 31.25% in PR. After applying radiotherapy, two patients with PR after ASCT reached CR. Median follow-up was 15.5 months (range 3-133 months). The probability of overall survival (OS) and progression-free survival (PFS) at a 3-year period for all patients was 51.9 % and 48.9%, respectively. For 22 patients in CR after ASCT, a 3-year DFS was 66.5%. Estimates of 2.5-year survival were 14.3%, 61.9% and 100% for CRD, CSR and for patients with CR/PR, respectively (p < 0.01). However, when patients undergoing consolidation were analyzed separately from those in CSR, no significant difference in OS and PFS was observed according to the disease status at ASCT. In univariate analysis for OS, PFS i DFS, extranodal site of disease and disease bulk had no predictive value. Twelve patients died. The main cause of death was Hodgkin's disease. Transplant-related mortality was 3.1%. One patient with CRD developed secondary acute myeloid leukemia and died 28 months after the transplantation. CONCLUSION Autologous SCT is efficient as consolidation therapy in high-risk patients and in chemosensitive relapse, but it has no benefit in patients with chemoresistant disease.
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Canioni D, Deau-Fischer B, Taupin P, Ribrag V, Delarue R, Bosq J, Rubio MT, Roux D, Vasiliu V, Varet B, Brousse N, Hermine O. Prognostic significance of new immunohistochemical markers in refractory classical Hodgkin lymphoma: a study of 59 cases. PLoS One 2009; 4:e6341. [PMID: 19623262 PMCID: PMC2710003 DOI: 10.1371/journal.pone.0006341] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Accepted: 06/15/2009] [Indexed: 11/18/2022] Open
Abstract
Although most classical Hodgkin lymphoma patients are cured, a significant minority fail after primary therapy and may die as result of their disease. To date, there is no consensus on biological markers that add value to usual parameters (which comprise the International Prognostic Score) used at diagnosis to predict outcome. We evaluated 59 patients (18 with primary refractory or early relapse disease and 41 responders) for bcl2, Ki67, CD20, TiA1 and c-kit expression by semi-quantitative immunohistochemical study and correlated the results with the response to treatment. The results showed that expression of bcl2 and CD20 in Hodgkin and Reed Sternberg cells, and expression of TiA1 in micro-environmental lymphocytes, and c-kit positive mast cells in microenvironment, were independent prognostic markers. These novel cHL markers could be used in association with clinical parameters to identify newly diagnosed patients with favorable or unfavorable prognosis and to better tailor treatment for different risk groups.
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Affiliation(s)
- Danielle Canioni
- Department of Pathology, Necker Hospital, Assistance Publique-Hôpitaux de Paris, University Paris-Descartes, Faculté de Médecine, Paris, France.
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Verholen F, Terrettaz M, Roosnek E, Passweg JR, Chalandon Y. Hodgkin's lymphoma relapsing after autologous transplantation: allogeneic hematopoietic stem cell transplantation using a strategy of reduced intensity conditioning, and T-cell depletion with T-cell add-back. Eur J Haematol 2009; 83:273-5. [PMID: 19500136 DOI: 10.1111/j.1600-0609.2009.01282.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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50
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Sibon D, Brice P. Optimal treatment for relapsing patients with Hodgkin lymphoma. Expert Rev Hematol 2009; 2:285-95. [PMID: 21082970 DOI: 10.1586/ehm.09.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Relapsed or refractory classical Hodgkin lymphoma (HL) remains a therapeutic challenge. Patients with relapsed HL should be identified according to their prognostic factors at relapse (duration of remission and extranodal disease or stage). Patients with refractory disease, defined as progression during induction treatment or within 90 days after the end of treatment, have the worst prognosis. Following non-crossresistant salvage chemotherapy to achieve cytoreduction, high-dose therapy (HDT) and autologous stem cell transplantation has been shown to be better than conventional-dose chemotherapy for first-relapse/refractory HL. For patients with very unfavorable relapse or primary refractory HL, outcome remains poor with HDT. For these patients, the role of tandem HDT or allogeneic stem cell transplantation will be discussed. In this setting, novel investigational treatments will be presented.
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Affiliation(s)
- David Sibon
- Hopital Saint Louis, 1 Avenue Claude Vellefeaux, Paris cedex 10, France.
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