scholarly journals Allogeneic Stem Cell Transplantation for Relapsed and Refractory Hodgkin Lymphoma: Real World Experience of a Single Center

2021 ◽  
Vol 27 ◽  
Author(s):  
A. Kopińska ◽  
A. Koclęga ◽  
A. Wieczorkiewicz-Kabut ◽  
K. Woźniczka ◽  
D. Kata ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Hodgkin Lymphoma ◽  
Cell Transplantation ◽  
Allogeneic Stem Cell Transplantation ◽  
Checkpoint Inhibitors ◽  
Disease Status ◽  
Term Survival ◽  
Entire Cohort

Introduction: Refractory and relapsed Hodgkin lymphoma (R/R HL) is associated with poor prognosis, and allogeneic stem cell transplantation (allo-SCT) remains the only potentially curative approach.Aim: The aim of the study was to evaluate the feasibility of allotransplantation in R/R HL setting.Material: Overall, 24 patients (17 men and 7 women) at a median age of 27 years (range 18–44) underwent allo-SCT between 2002 and 2020.Results: Nineteen patients received prior autologous stem cell transplantation (ASCT1) whereas eight patients received second ASCT (ASCT2) after failure of ASCT1. Six patients received only brentuximab vedotin (BV; n = 4) or BV followed by checkpoint inhibitors (CPI; n = 2) before entering allo-SCT. Median time from ASCT1 to allo-SCT was 17.1 months. Fifteen patients received grafts from unrelated donors. Peripheral blood was a source of stem cells for 16 patients. Reduced-intensity conditioning was used for all patients. Disease status at transplant entry was as follows: complete remission (CR; n = 4), partial response (PR; n = 10), and stable disease (SD; n = 10). Acute and chronic graft-versus-host disease (GVHD) developed in 13 (54%) and 4 (16%) patients, respectively. Median follow-up for the entire cohort was 13.3 months. At the last follow-up, 17 (71%) patients died. The main causes of death were disease progression (n = 10), infectious complications (n = 6), and steroid-resistant GVHD (n = 1). Non-relapse mortality at 12 months was 25%. At the last follow-up, seven patients were alive; six patients were in CR, and one had PR. The 2-year overall survival (OS) was 40%.Conclusion: Chemosensitive disease at transplant was associated with better outcome. Allo-SCT allows for long-term survival in refractory and relapsed HL.

scholarly journals Immunotherapy in myeloma: how far have we come?

2019 ◽  
Vol 10 ◽  
pp. 204062071882266 ◽  
Author(s):  
Laurens E. Franssen ◽  
Tuna Mutis ◽  
Henk M. Lokhorst ◽  
Niels W. C. J. van de Donk
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Allogeneic Stem Cell Transplantation ◽  
Checkpoint Inhibitors ◽  
New Drugs ◽  
High Rate ◽  
High Dose ◽  
Cell Surface Antigens ◽  
Term Survival

The treatment of multiple myeloma (MM) has evolved substantially over the past decades, leading to a significantly improved outcome of MM patients. The introduction of high-dose therapy, especially, and autologous stem cell transplantation, as well as the development of new drugs, such as immunomodulatory drugs (IMiDs) and proteasome inhibitors have contributed to the improvement in survival. However, eventually most MM patients relapse, which indicates that there is a need for new agents and novel treatment strategies. Importantly, the long-term survival in a subset of MM patients after allogeneic stem cell transplantation illustrates the potential of immunotherapy in MM, but allogeneic stem cell transplantation is also associated with a high rate of treatment-related mortality. Recently, a better insight into several immune-evasion mechanisms, which contribute to tumor progression, has resulted in the development of active and well-tolerated novel forms of immunotherapy. These immunotherapeutic agents can be used as monotherapy, or, even more successfully, in combination with other established anti-MM agents to further improve depth and duration of response by preventing the outgrowth of resistant clones. This review will discuss the mechanisms used by MM cells to evade the immune system, and also provide an overview of currently approved immunotherapeutic drugs, such as IMiDs (e.g. lenalidomide and pomalidomide) and monoclonal antibodies that target cell surface antigens present on the MM cell (e.g. elotuzumab and daratumumab), as well as novel immunotherapies (e.g. chimeric antigen receptor T-cells, bispecific antibodies and checkpoint inhibitors) currently in clinical development in MM.

Immunotherapy and Chemotherapy Can Result in Long-Term Survival for Patients with Recurrent or Progressive Non-Hodgkin’s Lymphoma after Reduced-Intensity Allogeneic Stem Cell Transplantation.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1643-1643
Author(s):  
Michael R. Bishop ◽  
Robert M. Dean ◽  
Wyndham H. Wilson ◽  
Jeanne Odom ◽  
Seth Steinberg ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Allogeneic Stem Cell Transplantation ◽  
Progressive Disease ◽  
Disease Status ◽  
Term Survival ◽  
Probability Of Survival ◽  
Reduced Intensity

Abstract Reduced-intensity allogeneic stem cell transplantation (RIST) has been demonstrated to clinically benefit patients (pts) with relapsed, chemotherapy-sensitive non-Hodgkin’s lymphoma (NHL). The most significant challenge after RIST is treatment of recurrent or progressive disease, and the subsequent outcomes of NHL pts, who either have progressed or relapsed after RIST, have not been previously reported. To address this question we performed a retrospective analysis on 35 pts who had undergone RIST from HLA-matched siblings for refractory/relapsed NHL (excluding CLL/SLL). Outcomes were analyzed from Day +100 on, as all pts had achieved complete donor chimerism by this time point and this was a scheduled time of disease assessment as per protocol. All pts had received the identical reduced-intensity conditioning regimen consisting of fludarabine and cyclophosphamide and had received cyclosporine (CSA)-based GVHD prophylaxis. For pts with recurrent or progressive NHL, we employed a sequential approach of CSA withdrawal, followed by rituximab (ritux), followed by donor lymphocyte infusion (DLI), and then followed by chemotherapy +/− DLI; specific treatment was dependent upon the presence or absence of GVHD and CD20 expression. At Day +100 post-RIST 23/35 pts were in a complete remission (CR) of which 4 (DLC = 2, FCC = 1, MCL = 1) were subsequently observed to relapse. The disease status at Day +100 among the remaining 12 pts (DLC = 10, FCC = 1, PTCL =1) not in CR at Day +100 post-RIST was partial remission (PR) = 2, stable disease (SD) = 1, and progressive disease (PD) = 9, as compared to pre-RIST evaluation. Among the 4 pts who relapsed after an initial CR post-RIST, 3 had CSA withdrawn, 1 received ritux, 3 received DLI, and 2 received chemotherapy + ritux. There subsequently were 3 CR and 1 PR. CR were maintained 12, 24+, and 26+ months after intervention. Three of these 4 pts are alive, and the 12 month probability of survival beyond Day +100 post-RIST was 75%. Among the 12 pts who were not in CR at Day +100 post-RIST, all 12 subsequently had CSA withdrawn, 7 received ritux, 5 received chemotherapy, and 3 received DLI. For the 2 pts in PR at Day +100 both achieved a CR by 6 months post-RIST. The one SD patient achieved a PR and died +11 months post-RIST. Among the 9 pts with PD at Day +100, 2 achieved CR, which have been maintained for 22+ and 4+ months, respectively. The 12 month probability of survival beyond Day +100 post-RIST for the 12 pts not in CR at Day +100 was 44%. The 12 month probability of survival beyond Day +100 post-RIST for all 16 pts was 52%. These data demonstrate that relapse after achievement of CR post-RIST is low, and that the majority of these patients can achieve sustained survival with post-transplant therapies. For NHL pts who do not initially achieve a CR at Day +100 post-RIST, subsequent outcome appears to correlate with disease status at Day +100; however, sustained, complete remissions could be achieved for a minority of patients with progressive disease post-RIST. These data indicate that further immunotherapy and additional chemotherapy can result in significant long-term survival for NHL pts with recurrent or progressive disease post-RIST.

scholarly journals The Burden of Survivorship on Hematological Patients—Long-Term Analysis of Toxicities after Total Body Irradiation and Allogeneic Stem Cell Transplantation

Cancers ◽  
2021 ◽  
Vol 13 (22) ◽  
pp. 5640
Author(s):  
Michael Oertel ◽  
Jonas Martel ◽  
Jan-Henrik Mikesch ◽  
Sergiu Scobioala ◽  
Christian Reicherts ◽  
...  
Keyword(s):  
Stem Cell ◽  
Side Effects ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Allogeneic Stem Cell Transplantation ◽  
Total Body Irradiation ◽  
Whole Body ◽  
Total Body

Total body irradiation is an effective conditioning modality before autologous or allogeneic stem cell transplantation. With the whole body being the radiation target volume, a diverse spectrum of toxicities has been reported. This fact prompted us to investigate the long-term sequelae of this treatment concept in a large patient cohort. Overall, 322 patients with acute leukemia or myelodysplastic syndrome with a minimum follow-up of one year were included (the median follow-up in this study was 68 months). Pulmonary, cardiac, ocular, neurological and renal toxicities were observed in 23.9%, 14.0%, 23.6%, 23.9% and 20.2% of all patients, respectively. The majority of these side effects were grades 1 and 2 (64.9–89.2% of all toxicities in the respective categories). The use of 12 Gray total body irradiation resulted in a significant increase in ocular toxicities (p = 0.013) and severe mucositis (p < 0.001). Renal toxicities were influenced by the age at transplantation (relative risk: 1.06, p < 0.001) and disease entity. In summary, total body irradiation triggers a multifaceted, but manageable, toxicity profile. Except for ocular toxicities and mucositis, a 12 Gray regimen did not lead to an increase in long-term side effects.

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