Stem Cell Transplantation
Allogeneic stem cell transplantation after reduced intensity conditioning in patients with relapsed or refractory Hodgkin’s lymphoma. Results of the HDR-ALLO study – a prospective clinical trial by the Grupo Español de Linfomas/ Trasplante de Médula Osea (GEL/TAMO) and the Lymphoma Working Party of the European Group for Blood and Marrow Transplantation Anna Sureda,1,2 Carme Canals,3 Reyes Arranz,4 Dolores Caballero,5 Josep Maria Ribera,6 Mats Brune,7 Jacob Passweg,8 Rodrigo Martino,1 David Valcárcel,1 Joan Besalduch,9 Rafael Duarte,10 Angel León,11 Maria Jesus Pascual,12 Ana García-Noblejas,4 Lucia López Corral,5 Bianca Xicoy,6 Jordi Sierra,1 and Norbert Schmitz13 1 Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; 2Department of Haematology, Addenbrooke’s Hospital, Cambridge, UK; 3EBMT Office, Barcelona, Spain; 4Hematology Department, Hospital de la Princesa, Madrid, Spain; 5 Hematology Department, Hospital Clínico Universitario, Salamanca, Spain; 6Hematology Department, ICO-Hospital Germans Trias i Pujol, Badalona, Spain; 7Hematology Section, Sahlgrenska University Hospital, Göteborg, Sweden; 8Departement Medecine Interne, Hopitaux Universitaires de Geneve, Geneve, Switzerland; 9Hematology Department, Hospital Son Dureta, Palma de Mallorca, Spain; 10Institut Català d’Oncologia, L’Hospitalet de Llobregat, Spain; 11Hematology Department, Hospital de Jerez de la Frontera, Jerez de la Frontera, Spain; 12Hematology Department, Hospital Carlos Haya, Málaga, Spain, and 13 Hematology/Oncology Department, Asklepios Klinik St. Georg, Hamburg, Germany
Although Hodgkin’s lymphoma is a highly curable disease with modern chemotherapy protocols, some patients are primary refractory or relapse after first-line chemotherapy or even after high-dose therapy and autologous stem cell transplantation. We investigated the potential role of allogeneic stem cell transplantation in this setting.
Manuscript received on April 11, 2011. Revised version arrived on September 5, 2011. Manuscript accepted on September 26, 2011. Correspondence: Anna Sureda MD PhD, Department of Haematogy Box 234 Addenbrooke’s Hospital Hills Road CB2 0QQ, Cambridge. Phone: international +44.1223596417. Fax: international +44.1223274669. E-mail: email@example.com
Design and Methods In this phase II study 92 patients with relapsed Hodgkin’s lymphoma and an HLA-identical sibling, a matched unrelated donor or a one antigen mismatched, unrelated donor were treated with salvage chemotherapy followed by reduced intensity allogeneic transplantation. Fourteen patients showed refractory disease and died from progressive lymphoma with a median overall survival after trial entry of 10 months (range, 6-17). Seventy-eight patients proceeded to allograft (unrelated donors, n=23). Fifty were allografted in complete or partial remission and 28 in stable disease. Fludarabine (150 mg/m2 iv) and melphalan (140 mg/m2 iv) were used as the conditioning regimen. Anti-thymocyte globulin was additionally used as graft-versus-host-disease prophylaxis for recipients of grafts from unrelated donors. Results The non-relapse mortality rate was 8% at 100 days and 15% at 1 year. Relapse was the major cause of failure. The progression-free survival rate was 47% at 1 year and 18% at 4 years from trial entry. For the allografted population, the progression-free survival rate was 48% at 1 year and 24% at 4 years. Chronic graft-versus-host disease was associated with a lower incidence of relapse. Patients allografted in complete remission had a significantly better outcome. The overall survival rate was 71% at 1 year and 43% at 4 years. Conclusions Allogeneic stem cell transplantation can result in long-term progression-free survival in heavily pre-treated patients with Hodgkin’s lymphoma. The reduced intensity conditioning approach significantly reduced non-relapse mortality;...