scholarly journals Transplant strategies in relapsed/refractory Hodgkin lymphoma

Blood ◽  
2018 ◽  
Vol 131 (15) ◽  
pp. 1689-1697 ◽  
Author(s):  
Gunjan L. Shah ◽  
Craig H. Moskowitz
Keyword(s):  
Side Effects ◽  
Hodgkin Lymphoma ◽  
Checkpoint Inhibitors ◽  
Remission Rate ◽  
Therapeutic Option ◽  
Response Rates ◽  
Hematopoietic Cell ◽  
High Dose ◽  
Cell Transplant ◽  
Hematopoietic Cell Transplant

Abstract The majority of patients with Hodgkin lymphoma (HL) are cured with initial therapy. However, high-dose therapy with autologous hematopoietic cell transplant (AHCT) allows for the cure of an additional portion of patients with relapsed or primary refractory disease. Positron emission tomography–negative complete remission before AHCT is critical for long-term disease control. Several salvage options are available with comparable response rates, and the choice can be dependent of comorbidities and logistics. Radiation therapy can also improve the remission rate and is an important therapeutic option for selected patients. Brentuximab vedotin (BV) maintenance after AHCT is beneficial in patients at high risk for relapse, especially those with more than 1 risk factor, but can have the possibility of significant side effects, primarily neuropathy. Newer agents with novel mechanisms of action are under investigation to improve response rates for patients with subsequent relapse, although are not curative alone. BV and the checkpoint inhibitors nivolumab and pembrolizumab are very effective with limited side effects and can bridge patients to curative allogeneic transplants (allo-HCT). Consideration for immune-mediated toxicities, timing of allogeneic hematopoietic cell transplant based on response, and the potential for increased graft-versus-host disease remain important. Overall, prospective investigations continue to improve outcomes and minimize toxicity for relapsed or primary refractory HL patients.

scholarly journals The Role of Hematopoietic Cell Transplant in the Glycoprotein Diseases

Cells ◽  
2020 ◽  
Vol 9 (6) ◽  
pp. 1411 ◽  
Author(s):  
Brianna M. Naumchik ◽  
Ashish Gupta ◽  
Heather Flanagan-Steet ◽  
Richard A. Steet ◽  
Sara S. Cathey ◽  
...  
Keyword(s):  
Therapeutic Option ◽  
Treatment Options ◽  
Lysosomal Storage Diseases ◽  
Hematopoietic Cell ◽  
Cell Transplant ◽  
Lysosomal Storage ◽  
Hematopoietic Cell Transplant ◽  
Psychomotor Delay ◽  
Enzyme Replacement ◽  
Enzyme Defects

The glycoprotein disorders are a group of lysosomal storage diseases (α-mannosidosis, aspartylglucosaminuria, β-mannosidosis, fucosidosis, galactosialidosis, sialidosis, mucolipidosis II, mucolipidosis III, and Schindler Disease) characterized by specific lysosomal enzyme defects and resultant buildup of undegraded glycoprotein substrates. This buildup causes a multitude of abnormalities in patients including skeletal dysplasia, inflammation, ocular abnormalities, liver and spleen enlargement, myoclonus, ataxia, psychomotor delay, and mild to severe neurodegeneration. Pharmacological treatment options exist through enzyme replacement therapy (ERT) for a few, but therapies for this group of disorders is largely lacking. Hematopoietic cell transplant (HCT) has been explored as a potential therapeutic option for many of these disorders, as HCT introduces functional enzyme-producing cells into the bone marrow and blood along with the engraftment of healthy donor cells in the central nervous system (presumably as brain macrophages or a type of microglial cell). The outcome of HCT varies widely by disease type. We report our institutional experience with HCT as well as a review of the literature to better understand HCT and outcomes for the glycoprotein disorders.

Brentuximab vedotin as consolidation after hematopoietic cell transplant for relapsed Hodgkin lymphoma in pediatric patients

2019 ◽  
Vol 66 (12) ◽  
Author(s):  
Jamie E. Flerlage ◽  
Xinyu Buttlar ◽  
Matthew Krasin ◽  
Brandon Triplett ◽  
Sue C. Kaste ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Pediatric Patients ◽  
Brentuximab Vedotin ◽  
Hematopoietic Cell ◽  
Cell Transplant ◽  
Hematopoietic Cell Transplant

Defining a Hodgkin lymphoma population for novel therapeutics after relapse from autologous hematopoietic cell transplant

2013 ◽  
Vol 54 (11) ◽  
pp. 2531-2533 ◽  
Author(s):  
Sally Arai ◽  
Michelle Fanale ◽  
Sven deVos ◽  
Andreas Engert ◽  
Tim Illidge ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Hematopoietic Cell ◽  
Cell Transplant ◽  
Hematopoietic Cell Transplant ◽  
Novel Therapeutics

Long-Term Outcomes of Myeloablative Hematopoietic Cell Transplantation Using Total Body Irradiation Prior to Systemic Therapy

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4552-4552
Author(s):  
Cara L. Toretta ◽  
Andrzej Niemierko ◽  
Erin Coughlin ◽  
Steven L. McAfee ◽  
Bimalangshu R. Dey ◽  
...  
Keyword(s):  
Skin Cancer ◽  
Hodgkin Lymphoma ◽  
Systemic Therapy ◽  
Total Body Irradiation ◽  
Hematopoietic Cell ◽  
Myelogenous Leukemia ◽  
High Dose ◽  
Cell Transplant ◽  
Conditioning Regimens ◽  
Total Body

Abstract Abstract 4552 Background: Myeloablative total body irradiation (TBI) may be incorporated in the condition regimen prior to hematopoietic cell transplant (HCT) for a variety of hematologic malignancies. Recent studies suggest improved patient tolerance and similar overall outcomes when TBI is administered prior to chemotherapy versus after systemic therapy. Patients and Methods: We retrospectively reviewed outcomes of adult patients (>18yrs old) who received myeloablative TBI as part of their conditioning regimen at the Massachusetts General Hospital between 1993 and 2012. All patients received TBI prior to chemotherapy; a median dose 13 Gy (range 12–16 Gy) was delivered. Patient characteristics including presenting disease, treatment course, treatment outcome and late-effects of therapy were analyzed. Results: The study cohort consisted of 116 patients; 55 patients received TBI for non-Hodgkin lymphoma (NHL), 25 for acute lymphoblastic leukemia (ALL), 16 for acute myelogenous leukemia (AML), 5 for chronic myelogenous leukemia (CML), 9 for Hodgkin lymphoma (HL), and 6 for other hematologic disease including MDS, MM, and CLL. Ten patients died of transplant-related mortality. Sixty-three patients underwent allogeneic HCT with a matched-related donor, 53 patients underwent autologous HCT, 5 patients had a tandem HCT, and the remaining patients were divided evenly among umbilical cord, haploidentical, and matched unrelated donor HCT. Twice daily TBI was administered for most patients; 56 cases received TBI three times daily. Cyclophosphamide + TBI (Cy/TBI) was the most commonly used regimen (n=100). At the time of this report, 56 patients were still alive, with a median followup of 84.7 months (range 0.5–220 months). Median survival for all 116 cases was 67 months; stratified by diagnosis: 112 months NHL, 50 months HL, 69 months ALL, 20 months AML, 17 months CML, and 36 months for other malignancies. Overall survival for the entire cohort was 53% (95% CI = 43 to 62%) and 43% (95% CI = 32 to 53%) at 5- and 10-years, respectively. Progression free or relapse-free survival (P/RFS) was 44% (95% CI = 34 to 54%) and 33% (95% CI = 23 to 43%) at 5- and 10-years, respectively. Patients with ALL had the longest P/RFS (69 months) followed by NHL (42 months). Thirteen patients developed second malignancies; 9 patients developed skin cancer, 2 were diagnosed with other solid tumors, and 2 patients had both skin cancer and another malignancy. Endocrine dysfunction such as hypothyroidism and hypogonadism was documented in 11 patients, 23 patients developed late ocular toxicity. Other late toxicities include pulmonary (14 patients), cardiac (4 patients), and 11 cases of neuropathy. None of these late toxicities were seen in patients with less than 2.5 years of survivorship after transplant. Conclusion: Similar to other reports, our results show that conditioning regimens that include the use of TBI prior to high-dose chemotherapy have OS and P/RFS that are comparable to other conditioning regimens. Appropriate screening for late toxicities of therapy should begin in the 3rd year of survivorship. Disclosures: No relevant conflicts of interest to declare.

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