Combined immunoradiotherapy induces long-term remission of CNS relapse of peripheral, diffuse, large-cell lymphoma after allogeneic stem cell transplantation: Case study

Abstract The prognosis of patients (pts) with NHL who relapse after autoHCT is poor. Myeloablative allogeneic hematopoietic stem cell transplantation has been utilized in these pts since the allograft is tumor free and may induce a graft-versus-tumor effect. Unfortunately, this approach results in prolonged survival for only a minority of pts. NMHCT is increasingly utilized in this setting since it affords the potential benefits of myeloablative transplantation and may reduce morbidity and treatment-related mortality (TRM). Reports using this approach show conflicting results but are limited by small numbers of pts. The purpose of this study was to determine the outcome of pts with NHL who underwent NMHCT after autoHCT failure including TRM, progression/relapse rate, overall survival (OS) and progression free survival (PFS). The study included 267 pts who underwent NMHCT for relapsed B cell NHL after autoHCT failure, from 1997 to 2006 and reported to the Center for International Blood and Marrow Transplant Research. Patients younger than 21, pts who underwent planned second transplants and recipients of cord blood transplants were excluded. The median age at NMHCT was 52 yrs (range 23–70); 64% were male and 61% had a Karnofsky Performance Score (KPS) of ≥ 90%. Fifty six percent of pts had diffuse large cell lymphoma, immunoblastic or follicular large cell lymphoma; 17% had follicular small or mixed NHL and 27% had mantle cell lymphoma. The time interval from 1st to 2nd transplant was < 1 year in 21% of pts, 1 to 2 years in 30% and > 2 years in 49% of pts. At the time of NMHCT, 63% had chemosensitive NHL, 31% resistant NHL and 6% were untreated after autoHCT. Multiple conditioning regimens were used including most frequently melphalan (25%) busulfan (21%) and fludarabine ± cyclophosphamide (26%). A fourth of the pts received 200 cGy of total body irradiation (TBI) as part of the conditioning regimen. The graft source was peripheral blood in 78% and 90% used unrelated donors. Median follow up of survivors was 37 months. TRM at 3 years was 42%. The cumulative incidence of disease progression at 3 years was 36%. The three-year probabilities of OS (figure 1) and PFS were 33% and 22%, respectively. The incidence of grade II-IV acute graft-versus-host disease (AGVHD) at 100 days was 39% and the incidence of chronic GVHD at 3 years was 41%. The most frequent causes of death were progression of NHL (29%), infection (19%), multiorgan failure (19%) and GVHD (14%). Factors associated with a lower risk of NHL progression or death include KPS ≥ 90%, interval between transplants >24 months, TBI as part of the conditioning regimen and complete remission at the time of NMHCT (figure 2). AGVHD decreased the risk of relapse (RR = 0.59, p=0.036) Figure 1 Figure 1. Figure 2 Figure 2.

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Cryofibrinogenemia and skin necrosis in a patient with diffuse large cell lymphoma after high-dose chemotherapy and autologous stem cell transplantation

Bone Marrow Transplantation ◽

10.1038/sj.bmt.1702678 ◽

2000 ◽

Vol 26 (12) ◽

pp. 1343-1345 ◽

Cited By ~ 7

Author(s):

A Shimoni ◽

M Körbling ◽

R Champlin ◽

J Molldrem

Keyword(s):

Stem Cell ◽

Stem Cell Transplantation ◽

Autologous Stem Cell Transplantation ◽

Skin Necrosis ◽

Cell Lymphoma ◽

Large Cell ◽

High Dose Chemotherapy ◽

High Dose ◽

Diffuse Large Cell Lymphoma ◽

Large Cell Lymphoma

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Alectinib, an anaplastic lymphoma kinase (ALK) inhibitor, as a bridge to allogeneic stem cell transplantation in a patient with ALK‐positive anaplastic large‐cell lymphoma refractory to chemotherapy and brentuximab vedotin

Clinical Case Reports ◽

10.1002/ccr3.2543 ◽

2019 ◽

Vol 7 (12) ◽

pp. 2500-2504 ◽

Cited By ~ 2

Author(s):

Ritsuko Nakai ◽

Suguru Fukuhara ◽

Akiko Miyagi Maeshima ◽

Sung‐Won Kim ◽

Yuta Ito ◽

...

Keyword(s):

Stem Cell ◽

Stem Cell Transplantation ◽

Allogeneic Stem Cell Transplantation ◽

Cell Lymphoma ◽

Large Cell ◽

Brentuximab Vedotin ◽

Anaplastic Lymphoma ◽

Alk Inhibitor ◽

Large Cell Lymphoma ◽

Alk Positive

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Allogeneic Stem Cell Transplantation Is Able to Induce Long-Term Remissions in Angioimmunoblastic T-Cell Lymphoma: A Retrospective Study From the Lymphoma Working Party of the European Group for Blood and Marrow Transplantation

Journal of Clinical Oncology ◽

10.1200/jco.2008.20.4628 ◽

2009 ◽

Vol 27 (24) ◽

pp. 3951-3958 ◽

Cited By ~ 115

Author(s):

Charalampia Kyriakou ◽

Carmen Canals ◽

Jürgen Finke ◽

Guido Kobbe ◽

Jean-Luc Harousseau ◽

...

Keyword(s):

Stem Cell ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

Allogeneic Stem Cell Transplantation ◽

Marrow Transplantation ◽

Cell Lymphoma ◽

Angioimmunoblastic T Cell Lymphoma ◽

Blood And Marrow Transplantation ◽

European Group

Purpose To analyze the long-term outcome in terms of nonrelapse mortality (NRM), relapse rate (RR), progression-free survival (PFS), and overall survival (OS) in patients with angioimmunoblastic T-cell lymphoma (AITL) treated with allogeneic stem-cell transplantation (alloSCT). Patients and Methods Forty-five patients with AITL who had undergone an alloSCT between January 1998 and December 2005 and were registered in the European Group for Blood and Marrow Transplantation database were analyzed. Median age was 48 years (range, 23 to 68 years), 34 patients had received ≥ two lines of chemotherapy before alloSCT, and 11 patients had experienced treatment failure with a prior autologous stem-cell transplantation. Twenty-five patients underwent a myeloablative alloSCT, and 20 underwent a reduced-intensity alloSCT. Donors were HLA-identical siblings in 26 patients. Twenty-seven patients were allografted in chemotherapy-sensitive disease, and 18 were allografted in refractory disease. Results The cumulative incidence of NRM was 18%, 22%, and 25% at 3, 6, and 12 months, respectively. Patients with poor performance status had a significantly higher NRM (P = .01). RR was estimated as 16% and 20% at 2 and 3 years, respectively, and was lower in patients developing chronic graft-versus-host disease (cGVHD). PFS and OS rates were 62% and 53% and 66% and 64% at 1 and 3 years, respectively, and were significantly better in chemotherapy-sensitive patients. Conclusion AlloSCT represents a valid therapeutic option for patients with AITL. Both the lower RR after transplantation as well as the decreased RR in patients developing cGVHD after the alloSCT suggests the existence of a clinically relevant graft-versus-lymphoma effect.

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