Reduced-Intensity Conditioning Allogeneic Hematopoietic Cell Transplantation Using Oral Fludarabine as Part of the Conditioning Regimen.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4925-4925
Author(s):  
Julio Delgado ◽  
Ana Marco ◽  
Estela Moreno ◽  
Jose L. Pinana ◽  
David Valcarcel ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Myeloid Leukemia ◽  
Hodgkin’S Lymphoma ◽  
Conditioning Regimen ◽  
Patient Characteristics ◽  
Hodgkin's Lymphoma ◽  
Mixed Chimerism ◽  
Reduced Intensity Conditioning ◽  
Conditioning Regimens ◽  
Reduced Intensity

Abstract Since its introduction in 2003, oral fludarabine has gradually replaced the intravenous (IV) formulation as treatment for patients with hematological malignancies. In an attempt to simplify the management of patients undergoing reduced intensity allogeneic transplantation, we have incorporated oral fludarabine to the conditioning regimen. We present a retrospective analysis of 37 patients conditioned with oral fludarabine compared with a historical cohort of 134 patients conditioned with the IV formulation. In addition to fludarabine, the conditioning regimens also included IV melphalan or oral busulfan depending on the underlying disease. Donors were HLA-matched siblings in 76% of cases and unrelated donors in the remaining 24%. Patient characteristics are summarized in Table 1. There were no statistical differences in terms of hospital admission (P = 0.414), time to neutrophil engraftment (P = 0.392), time to platelet engraftment (P = 0.307), acute graft-versus-host disease rate (P = 0.182) or non-relapse mortality at days +30 (P = 1.0) and +100 (P = 0.433). The subgroup of patients conditioned with oral fludarabine plus busulfan had a significantly higher incidence of mixed chimerism by day +100, but this did not translate into a significantly increased relapse rate. Side effects were tolerable and all patients on oral fludarabine were able to commence their conditioning regimen as outpatients. This preliminary analysis confirms that oral fludarabine could replace its IV formulation as part of reduced intensity conditioning regimens with no deleterious effect on any of the early transplantation outcomes. Furthermore, the use of oral fludarabine in combination with oral cyclophosphamide, oral busulfan or low dose total-body irradiation could potentially reduce hospital admission or even allow us to perform reduced-intensity allogeneic transplants as outpatient procedures. Finally, other advantages of oral fludarabine are cheaper costs and a more convenient use for both patients and health care workers. Patient characteristics according to fludarabine administration route Oral fludarabine (n = 37) IV fludarabine (n = 134) P value Age, median (range) 57 (38–69) 52 (18–70) 0.002 Sex, male/female % 60/40 65/35 0.566 Underlying diseases, n (%) 0.129 Acute myeloid leukemia 7 (19) 21 (16) Myelodysplastic syndrome 6 (16) 19 (14) Acute lymphoid leukemia 0 (0) 4 (3) Non-Hodgkin’s lymphoma 10 (27) 26 (18) Hodgkin’s lymphoma 0 (0) 30 (22) Myeloproliferative disorder 1 (3) 2 (2) Multiple myeloma 7 (19) 20 (15) Chronic lymphocytic leukemia 4 (11) 9 (7) Chronic myeloid leukemia 2 (5) 2 (2) Paroxysmal nocturnal hemoglobinuria 0 (0) 1 (1) Stem cell source, PB/BM % 100/0 93/7 0.121 Donor, n (%) 0.821 Matched related 29 (78) 101 (75) Mismatched related 0 (0) 2 (2) Matched unrelated 6 (16) 20 (15) Mismatched unrelated 2 (6) 11 (8) Previous autograft, n (%) 8 (22) 52 (39) 0.055 Conditioning regimen, n (%) 0.333 Fludarabine plus melphalan 21 (57) 89 (66) Fludarabine plus busulfan 16 (43) 45 (34) CD34+ cell dose (x106/kg), median (range) 6.1 (2.9–15) 6.5 (1.29–18.1) 0.787 Follow-up (days), median (range) 298 (83–631) 847 (80–1925) < 0.001

Reduced Intensity Conditioning Regimen for Allografting Following Autografting Is Feasible and Has a Strong Anti Multiple Myeloma Activity.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 5130-5130
Author(s):  
A.M. Carella ◽  
Germana Beltrami ◽  
Maria T. Corsetti ◽  
Potito Scalzulli ◽  
Nicola Cascavilla ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Progressive Disease ◽  
Chronic Gvhd ◽  
Intensive Therapy ◽  
Conditioning Regimen ◽  
Mixed Chimerism ◽  
Reduced Intensity Conditioning ◽  
Conditioning Regimens ◽  
Age Range ◽  
Reduced Intensity

Abstract The development of reduced intensity conditioning regimens (RICT) has renewed interest in allografting for patients with multiple myeloma (MM). Taking advantage of this new approach, we firstly postulated that combining maximal tumor reduction achieved with autografting and the benefits of RICT, we could achieve more cures of multiple myeloma (MM) with acceptable toxicity. Sixteen patients, 51 years of age (range, 36–63) with previously treated stage III MM were given melphalan 140 mg/m2 and autologous peripheral blood progenitor cells (PBPC) reinfusion. The regimen-related toxicities were moderate with a median of 8 and 11 days of neutropenia and thrombocitopenia, respectively. Forty-six to 156 days later (median, 79 days), the patients received fludarabine 30 mg/m2/d x 3 days plus 2 Gy TBI and HLA-identical donor mobilized PBPC. Postgrafting immunosuppression consisted of cyclosporine and mycophenolate mofetil. Donor lymphocyte infusions were given to eight patients with stable mixed chimerism or progressive disease who did not show signs of aGVHD. Engraftment occurred in 14 patients (87%). Ten patients (62%) are alive with 9 of them in continuous complete remission 11–36 months (median, 30 months) after transplants. All remitters patients achieved full chimerism and developed GVHD. Grade II–III acute GVHD occurred in 7 patients (43%) but no patient died of aGVHD. Three patients (18%) developed extensive chronic GVHD requiring intensive therapy. Six patients died; five of them of progressive disease and one of progressive disease combined with extensive cGVHD and interstitial pneumonitis. In conclusion, this 2-step approach is feasible and demonstrated to have a strong antimyeloma activity with reduced deaths due to acute toxicities.

Reduced Intensity Conditioning Regimen in Single Unrelated Cord Blood Transplantation in Adults with Hematological Malignant Disorders. An Eurocord-Netcord and SFGM-TC Survey.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3143-3143 ◽  
Author(s):  
Vanderson Rocha ◽  
Bernard Rio ◽  
Federico Garnier ◽  
Marc Renaud ◽  
Anne Sirvent ◽  
...  
Keyword(s):  
Cord Blood ◽  
Cord Blood Transplantation ◽  
Conditioning Regimen ◽  
Reduced Intensity Conditioning ◽  
Blood Transplantation ◽  
Reduced Intensity Conditioning Regimen ◽  
Conditioning Regimens ◽  
Unrelated Cord Blood ◽  
One Year ◽  
Reduced Intensity

Abstract Results of reduced intensity conditioning regimen (RIC) in unrelated cord blood transplantation (UCBT) have been reported, however more frequently RIC was performed using double cord blood transplants. In order to study risk factors in single RIC-UCBT we have analyzed 65 patients with hematological malignancies (ALL=10, AML=37, Hodking and NHL=10, MDS=4, CML=3, Myeloma =1) transplanted from 1999–2005 and reported to Eurocord and SFGM-TC. The median follow-up was 8 months (3–26) and the median age was 47 years (16–76). At transplant, 49% of the patients had advanced phase of disease and 39% had received a previous autologous transplants. The conditioning regimen varied according diasease and centers: Fludarabine(FLU)+Endoxan (EDX) +TBI (2Gy) was given to 33 patients, FLU+(EDX or Melphalan) in 11, FLU+BU (<8mg/kg) associated or not to other drugs in 13, FLU+TBI(2GY) in 3 and other regimens in 5 patients. ATG/ALG was added in 26% of the cases. GVHD prophylaxis most commonly (55%) consisted of CsA and MMF; 87% received hematopoietic growth factors (<day 8). The median nucleated cell dose infused was 2.4 x107/kg and the graft was HLA identical (6/6) ( HLA A and B low resolution and DRB1 allelic typing) in 3 cases, 5/6 in 15, 4/6 in 37 and 3/6 in 10. Results: Median time to neutrophil recovery (>500/mm3) was 20 days (0–56) and 35 dyas for platelets recovery (>20.000/mm3). At day 60 probability of neutrophil recovery was 87± 7% of the 33 patients who received the Flu+End+TBI conditioning regimen and was 65±10% for patients receiving other regimens (p<0.01). Chimerism analysis was available in 71% of the patients at 3 months and was full donor in 67%, mixed chimerism in 9% and autologous reconstitution in 24%. Grade II aGVHD was observed in 13%, grade III in 7% and grade IV in 7%; the TRM was 45±7% overall, 50±15% in acute leukemia, 30±15% in lymphomas and 27±16% for other diagnoses. The TRM at one year for those receiving <2.4 x 107 TNC/kg was 53±9% and for those receiving >2.4 x107TNC/kg was 39±10% (p=0.07). For patients receiving Flu+End+TBI the TRM at one year was 24±10% and for those receiving other conditioning regimens was 60±9% (p=0.001). DFS at one year for lymphomas was 50±9%, for leukemias was 27±7% and for other diagnoses was zero. When the HLA compatibility was 6/6 or 5/6, DFS at one year was 42±12%, for 4/6 disparities DFS was 27±9% and for 3/6 disparities DFS was zero. DFS was 43±11% for those receiving Flu+End+TBI, and was 16±7% for patients receiving other conditioning regimens (p=0.005). For patients receiving >2.4 x 107TNC/kg the DFS was 31±12% and for patients receiving <2.4 x 107TNC/kg the DFS was 14±8% (p=0.05). In collusion, results of single RIC-UCBT are encouraging; cell dose and HLA remain important factors in this setting. The type of conditioning (Flu+End+TBI) seems to be associated with decreased TRM and better DFS, but a multivariate analysis with a higher number of patients is needed.

Concurrent Fludarabine and Cyclophosphamide As a Reduced Intensity Conditioning Regimen Prior to Allogeneic Hematopoietic Stem Cell Transplantation Ablates Host T-Cells and Results in Rapid Full Donor Chimerism

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 1937-1937
Author(s):  
Rachel B. Salit ◽  
Michael R. Bishop ◽  
Steven Z. Pavletic ◽  
Frances T. Hakim ◽  
Seth M. Steinberg ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Conditioning Regimen ◽  
Reduced Intensity Conditioning ◽  
Myeloablative Conditioning ◽  
Hematopoietic Stem ◽  
Donor Chimerism ◽  
Conditioning Regimens ◽  
Reduced Intensity

Abstract Abstract 1937 Background: Reduced intensity conditioning (RIC) allogeneic hematopoietic stem cell transplantation (HSCT) is associated with decreased transplant-related mortality (TRM). However, RIC-HSCT is typically associated with higher rates of mixed chimerism and graft rejection compared to myeloablative conditioning. Host T-cell immunity has been demonstrated to be an important predictor of engraftment and establishment of full donor chimerism in clinical studies. It was previously demonstrated in murine models that concurrent fludarabine (F) and cyclophosphamide (C) ablated host T-cells to the extent of myeloablative total body irradiation with reduced myeloid cell toxicity and prevented rejection of fully MHC-disparate marrow allografts (Petrus et al, BBMT, 2000). While fludarabine and cyclophosphamide are agents commonly used in reduced intensity conditioning regimens, their concurrent use has never been reported. Here, we analyze results from 102 patients who received the reduced intensity conditioning FC regimen in the setting of matched related or unrelated allogeneic stem cell transplantation. Methods: On four consecutive protocols at the National Cancer Institute, hematologic malignancy patients received induction chemotherapy followed by the FC regimen: fludarabine 30 mg/m2/d, days −6 to −3 and cyclophosphamide 1200 mg/m2/d, days −6 to −3. Peripheral blood stem cells were infused on Day 0. GVHD prophylaxis was either a calcineurin inhibitor alone or in combination with other agents. Results: 102 patients (females, 36; males, 66) were enrolled on study. Median age was 50 yrs (range, 21–71). Diagnoses included AML/MDS (n = 2), HL (n = 12), DLBCL (n = 35), CLL (n = 13), FL (n = 12), MCL (n = 10) and TCL (n = 10). Median number of prior regimens = 3 (range, 1 – 9); 25 patients had prior autologous transplant. Transplants were performed using HLA - matched sibling donors (n = 82) or 10/10 matched unrelated donors (n = 20). At the time of study entry, disease status was defined as chemosensitive (n = 53) or chemorefractory (n = 49). Patients were in CR (n = 19), PR (n = 26), SD (n = 37), or PD (n = 19); one patient was not evaluable. 101 of 102 patients (99%) proceeded to transplant. Median CD3+, CD4+, and CD8+ lymphocyte counts after induction chemotherapy (pre-FC conditioning) were: 150 cells/μl (1–1557), 80 cells/μl (0–1332), and 52 cells/μl (52–1195), respectively. Following FC conditioning, median CD3+, CD4+, and CD8+ counts were: 3 cells/μl (0–65), 3 cells/μl (0–93), and 0 cell/μl (0–22) (each p< 0.0001). All patients engrafted. Median time to neutrophil engraftment (ANC > 500) was 10 days and platelet engraftment (plt > 20 48 hours post transfusion) was 11 days. At Day +14, median CD3+ chimerism was 100% (range 30–100%), CD14+/15+ chimerism was 100% (range 6–100%), and whole blood chimerism was 100% (range 11–100%). Patients maintained full donor chimerism as evidenced by median 100% (range 50–100%) whole blood chimerism at Day +100. By Day +28 post-transplant, 41 patients (40%) achieved (n=24) or maintained (n=17) a CR and 38 patients (37%) achieved or maintained a PR for an overall response rate of 77%. Fourteen patients had SD and 4 had PD. Day +100 and one year TRM were 7% and 15% respectively. With a median follow-up of 92.4 months, 1 yr and 2 yr EFS were 52% and 41% and 1 yr and 2 yr OS were 68% and 58% respectively. Both EFS (p = 0.0003) and OS (p = 0.01) were significantly associated with response to FC. Acute GVHD grades II-IV and III-IV occurred in 56% and 23% of patients respectively. The rate of chronic GVHD was 65%. Grade IV non-hematologic toxicities as of Day +28 post-transplant included cardiac (n = 7, n = 1 Grade V), pulmonary (n=9), GI (n=9), and neurologic (n=3). While 62% of patients had at least one Grade III infection, only 2 patients had a Grade IV infection. Conclusion: The concurrent FC conditioning regimen resulted in host T-cell ablation and rapid full donor chimerism characteristic of myeloablative conditioning regimens. Furthermore, RIC-HSCT using concurrent FC achieved a high rate of complete remissions with an acceptable safety profile. Disclosures: No relevant conflicts of interest to declare.

Lille Scoring System Rather Than DIPSS Is a Better Predictive of Overall Mortality After Allogeneic Hematopoietic Cell Transplantation (HCT) for Primary Myelofibrosis Using Reduced Intensity Conditioning: A Report From the Center for International Blood and Marrow Transplant Research (CIBMTR)

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 432-432
Author(s):  
Vikas Gupta ◽  
Kwang W Ahn ◽  
Xiaochun Zhu ◽  
Zhenhuan Hu ◽  
Parameswaran Hari ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
High Risk ◽  
Scoring System ◽  
Conditioning Regimen ◽  
Primary Myelofibrosis ◽  
Reduced Intensity Conditioning ◽  
Donor Type ◽  
Conditioning Regimens ◽  
Reduced Intensity ◽  
Overall Mortality

Abstract Abstract 432 The Dynamic International prognostic scoring system (DIPSS) is increasingly being used as a prognostic tool for determining the risk of mortality for primary myelofibrosis (PMF), and has largely replaced Lille scoring system. However, it is unclear whether this scale can predict mortality after reduced intensity conditioning (RIC) allogeneic HCT, a procedure that is increasingly being utilized, as demonstrated by data from the CIBMTR. Using the CIBMTR database, the impact of patient, disease and transplant related factors on outcomes of 222 patients, who underwent HCT for PMF using RIC was analyzed. Median follow-up of survivors was 50 months (range, 3–165). Median age at HCT was 55 years, and 56 (25%) were >60 years. Donors were matched related donor (MRD), well-matched unrelated (MUD), and partially/mismatched unrelated (MMUD) in 85 (38%), 94 (42%), and 43 (19%), respectively. Conditioning regimens were: Fludarabine (Flu) and Melphalan (Mel), 62 (28%); Flu and Busulphan (Bu), 81 (36%), Flu and total body irradiation (TBI), 49 (22%); and others 30 (14%). Disease-risk status at HCT according to Lille scoring system was: low 48 (22%), intermediate (Int) 105 (47%), and high 69 (31%); and according to DIPSS was: low 25 (11%), int-1 110 (50%), int-2 81 (36%), and high, 4 (2%). The cumulative incidences of acute graft versus host disease (GvHD) at 100 days and chronic GvHD at 5-years were 48% (95% confidence intervals [CI] 41–54) and 50% (95% CI 43–57), respectively. The cumulative incidence of relapse/progression and non-relapse mortality (NRM) at 5-years was 28% (95% CI 22–34) and 38% (95% CI 31–44), respectively. The corresponding disease-free and overall survival was 34% (95% CI 28–40), and 37% (95% CI 31–44), respectively. In multivariate analysis, high-risk disease defined by Lille scoring system was associated with two-fold higher mortality compared to low-risk disease (Table). Higher risk disease status as defined by DIPSS was not associated with a significant increase in mortality when compared to lower-risk disease (Table). MUD and MMUD use were associated with higher mortality risk compared to MRD with relative risk (RR) of 1.59 (95% CI 1.00–2.52) and 2.6 (95% CI 1.56–4.35), respectively. A comparison of conditioning regimens demonstrated a trend towards reduced mortality with FluMel when compared to FluBu (RR 0.56, 95% CI 0.33–0.92; overall p=0.11), or other regimens (RR 0.51, 95% CI 0.26–0.99; overall p=0.11). In conclusion, the current study highlights that the DIPSS was limited in predicting the mortality after RIC transplantation for PMF, while the Lille scoring system remained predictive of mortality in high risk patients. These findings underscore the need for transplant-specific scoring system. Compared to other conditioning regimens FluMel appears to be associated with a trend towards better survival, which needs to be confirmed in prospective randomized trials. Table. Multivariate Analysis (MVA) for overall mortality* Model 1. MVA of Lille scoring system Variable Relative Risk (RR) 95% CI Overall p-value Lille-risk score low-risk (n = 48) 1 0.02 Intermediate-risk (n = 105) 1.47 0.84-2.58 High risk (n = 69) 2.22 1.23-4.00 Conditioning regimen Flu TBI 1 0.11 Flu Mel 0.67 0.38-1.19 Flu Bu 1.20 0.73-1.97 Others 1.30 0.68-2.48 Donor type HLA-identical sibling/other related 1 0.001 Well-matched URD 1.60 1.01-2.53 Partially matched/mismatched URD 2.61 1.57-4.36 Contrast Flu Mel vs. Flu Bu 0.56 0.33-0.93 0.03 Flu Mel vs. Others 0.51 0.27-0.99 0.05 Flu Bu vs. Others 0.92 0.52-1.66 0.79 Intermediate vs. High 0.66 0.43-1.01 0.06 Well-matched URD vs. Partially matched/mismatched URD 0.61 0.38-0.98 0.04 Model 2. MVA of DIPSS DIPSS Low/Int-1 (n = 135) 1 0.10 Int-2/high (n = 85) 1.39 0.94-2.043 * Adjusted for age, sex, Karnofsky performance score, platelet count, spleen status, conditioning regimen, donor type, GVHD prophylaxis and year of transplant. Disclosures: No relevant conflicts of interest to declare.

Intravenous busulfan and cyclophosphamide as an autologous transplant conditioning regimen for relapsed non-Hodgkin’s lymphoma

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 16508-16508
Author(s):  
M. P. Escalon ◽  
D. L. Pereira ◽  
E. S. Santos ◽  
M. Goodman ◽  
J. J. Byrnes ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Hodgkin’S Lymphoma ◽  
Cell Lymphoma ◽  
Conditioning Regimen ◽  
Hodgkin's Lymphoma ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma ◽  
Conditioning Regimens

16508 Purpose: High-dose chemotherapy and hematopoietic stem cell transplantation has become the standard of care for chemosensitive relapsed Non-Hodgkin’s Lymphoma. Multiple conditioning regimens including CBV, BEAM, and BEAC have been used in the past with success. Limitations on the supply of carmustine have made it important to find other effective conditioning regimens. Methods: We retrospectively evaluated the use of intravenous Busulfan and Cyclophosphamide (IV Bu/Cy) as a conditioning regimen for autologous stem cell transplantation in Non-Hodgkin’s Lymphoma patients. Patients were given Busulfan 3.2 mg/kg total intravenously on days -7 to -4 (either once daily or in 2 or 4 divided doses) followed by Cyclophosphamide 120 mg/kg intravenously on days -2 and -1. Results: Forty-four patients, ages 20 to 68 years (median 50) were treated from January 2000 to April 2005. Most patients had diffuse large B-cell lymphoma (n = 29). Of the remaining patients, 8 had follicular lymphoma, 4 had mantle cell lymphoma and 3 had peripheral T-cell lymphoma. At the time of transplant, 27 patients had attained a complete response (CR or CRu) to salvage chemotherapy, 13 patients had achieved a partial response, and 4 had stable disease. The patients received a median of 3.0 × 106 CD34+ cells/kg (range 1.3–16.6 × 106). There were 4 treatment-related deaths by day 100: 1 from sepsis, 1 from pneumonia, and 2 from veno-occlusive disease (VOD). With a median follow-up of 42 months, 3-year Kaplan-Meier estimates of event free and overall survival for the entire cohort were 44% and 45%. For the patients that attained a CR or CRu prior to transplant, the EFS and OS were 42% and 53%, respectively. Conclusions: IV Bu/Cy is a safe and effective conditioning regimen. Due to the incidence of VOD, this regimen should be used with caution in patients with pre-existing hepatic dysfunction. Overall, our outcomes are comparable to that of other published regimens. Further investigation of Busulfan with Cyclophosphamide or with other chemotherapy combinations is warranted. No significant financial relationships to disclose.

Allogeneic Stem Cell Transplant (AlloSCT) for Hodgkin’s Lymphoma Which Has Relapsed Following Autologous SCT - Evidence for Potent Graft-Versus-Lymphoma Effect.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 3327-3327
Author(s):  
Andreas K. Klein ◽  
Chan Geoffrey ◽  
Kellie Sprague ◽  
Kenneth B. Miller ◽  
Francine Foss
Keyword(s):  
Overall Survival ◽  
Hodgkin’S Lymphoma ◽  
Median Overall Survival ◽  
Chronic Gvhd ◽  
Hodgkin's Lymphoma ◽  
Unrelated Donor ◽  
Cell Transplant ◽  
Reduced Intensity Conditioning ◽  
Relapsed Disease ◽  
Reduced Intensity

With the advent of reduced intensity conditioning regimens, new treatment options are available to patients who suffer relapse of Hodgkin’s lymphoma (HL) following autoSCT, but the efficacy of this procedure is not proven. We retrospectively compared the cohort of adult patients who received alloSCT for relapse of HL following autoSCT to those who did not at a single institution. 64 patients underwent autoSCT for HL between 7/87 and 5/02: 41 for relapsed disease, 16 for primary refractory disease and 7 unclassified. Thirty-five patients (55%) relapsed at a median 12.5 months (range 0.9 to 140) after autoSCT. Eleven patients underwent alloSCT a median of 182 (35 – 645) days after relapse; 7/11 received reduced intensity conditioning, 5/11 received SCT from an unrelated donor. Of 24 patients who had relapsed after autoSCT (and did not receive an alloSCT), 16 survived at least 6 months and were considered in this analysis. Acute graft-versus-host disease (GVHD) > grade 2 occurred in only one patient, 5 /9 evaluable patients developed chronic GVHD (2 extensive). Five recipients of alloSCT have died: 2 with relapsed disease, 2 with disseminated fungal infections and 1 with interstitial pneumonitis. 6 patients remain alive, 5 remain free of disease. Median event free survival is12.5 months for recipients of alloSCT with median follow up of 3.1 years. Median overall survival is 4.1 years (64 days – 12.5+ years) and estimated overall survival is 71% at 3 years. This compares favorably with a median overall survival of 1.4 years in patients who survived at least 6 months, but did not receive alloSCT after relapse. Improved survival in the alloSCT cohort demonstrates that potent graft-versus-lymphoma activity can be achieved against HL without significant GVHD.

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