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    Allo-HSCT in transplant-naive patients with Hodgkin lymphoma: a single-arm, multicenter study

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    Authors
    Das-Gupta, E
    Thomson, KJ
    Bloor, Adrian
    Clark, AD
    Mackinnon, S
    Kayani, I
    Clifton-Hadley, L
    Patrick, P
    El-Mehidi, N
    Lawrie, A
    Kirkwood, AA
    Russell, NH
    Linch, DC
    Peggs, KS
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    Affiliation
    Nottingham University Hospital, Nottingham, United Kingdom
    Issue Date
    2019
    
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    Abstract
    We evaluated the role of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in transplant-na•ve patients with relapsed/refractory Hodgkin lymphoma (HL) who failed to attain metabolic complete response (mCR) to 1 to 2 lines of salvage chemotherapyThose with residual but nonprogressive disease assessed by positron emission tomography/computed tomography scanning were eligible. An additional 1 to 2 cycles of salvage therapy were permissible in those with progressive disease or when required to bridge to allo-HSCT, with additional imaging at baseline before transplantation. Conditioning consisted of carmustine, etoposide, cytarabine, melphalan, and alemtuzumab. Donor lymphocyte infusions (DLI) were administered for mixed chimerism or residual or relapsed disease. Eleven patients had sibling donors, 13 had HLA-matched unrelated donors, and 7 had HLA-mismatched unrelated donors. There were no graft failures, and no episodes of grade 4 acute graft-versus-host disease (GVHD); only 19.4% of patients had grade 2 to 3 GVHD, and 22.2% had extensive chronic GVHD. The non-relapse mortality rate was 16.1% (95% confidence interval [CI], 7.1%-34.5%). Relapse incidence was 18.7% (95% CI, 8.2%-39.2%). The study met its primary objective, with a 3-year progression-free survival of 67.7% (95% CI, 48.4%-81.2%). Survival outcomes were equivalent in those with residual metabolically active disease immediately before transplantation (n = 24 [70.8%; 95% CI, 17.2%-83.7%]). Two of the 5 patients who relapsed received DLI and remained in mCR at latest follow-up, with a 3-year overall survival of 80.7% (95% CI, 61.9%-90.8%). We demonstrate encouraging results that establish a potential role for allo-HSCT in selected high-risk patients with HL. This trial was registered at www.clinicaltrials.gov as #NCT00908180.
    Citation
    Das-Gupta E, Thomson KJ, Bloor AJC, Clark AD, Mackinnon S, Kayani I, et al. Allo-HSCT in transplant-naive patients with Hodgkin lymphoma: a single-arm, multicenter study. Blood Adv. 2019;3(24):4264-70.
    Journal
    Blood Advances
    URI
    http://hdl.handle.net/10541/622723
    DOI
    10.1182/bloodadvances.2019001016
    PubMed ID
    31869413
    Additional Links
    https://dx.doi.org/10.1182/bloodadvances.2019001016
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.1182/bloodadvances.2019001016
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