Blood cancers

‘Good news’ for allo-HSCT as first transplant in high risk Hodgkin’s lymphoma patients

A new analysis has provided further evidence that use of allogeneic-HSCT in transplant-naive high-risk Hodgkin’s lymphoma patients is “a reasonable strategy” and a potential alternative to autologous-HSCT.

The retrospective analysis, carried out by The Lymphoma Working Party, also indicates that the best strategy for first transplant success in patients eligible for allo-HSCT is to use myeloablative conditioning (MAC) with T-cell depletion (TCD).

The group analysed data from 190 eligible patients taken from the European Blood and Marrow Transplantation (EBMT) registry, most of which were categorised as high risk because they had had three or more lines of treatment prior to transplant. 

Of those included in the analysis, 63% had previously received brentuximab vedotin and/or checkpoint inhibitors, 37% had received an unrelated donor allo-HSCT, 51% had MAC, and 60% had in vivo TCD.

The findings, published in the British Journal of Haematology, showed three-year overall survival (OS) and progression free survival (PFS) to be 58% and 41% post transplant, respectively. 

The 100-day cumulative incidence (CI) of grade II-IV acute graft-versus-host disease (GVHD) was 25% while the 3-year CI of chronic GVHD was 38%, the data showed.

Furthermore, multivariate analysis indicated that the type of conditioning regimen and TCD “were the key factors linked with transplant outcomes,” the authors noted.

“MAC regimens using TCD (alemtuzumab or ATG) had similar NRM (non-relapse mortality; 19%) and a lower relapse rate than RIC [fludarabine plus busulfan, fludarabine plus melphalan] regimens with or without TCD, resulting in significantly better OS and PFS,” they said. 

“For the treatment of Hodgkin’s lymphoma it’s a good news story,” Dr Adrian Bloor, Consultant Haematologist at The Christie NHS Foundation Trust and trial investigator told the limbic. “What [the analysis] shows is that for people who have difficult disease you can use donor stem cells to achieve long term remission.”

Many centres in the UK have already adopted this treatment approach, but Dr Bloor agrees that the evidence from this study could encourage those that aren’t yet considering doing so. “It’s a reminder that if you have someone with really difficult disease, a donor transplant is a really effective and legitimate option,” he stressed.

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