UNMANIPULATED HAPLOIDENTICAL STEM CELL TRANSPLANTATION FOLLOWING BUSULFAN BASED REDUCED INTENSITY CONDITIONING AND POST-TRANSPLANTATION CYCLOPHOSPHAMIDE FOR ADVANCED HODGKIN´S LYMPHOMA
(Abstract release date: 05/19/16)
EHA Library. Díez J. 06/09/16; 133053; E1504
Dr. Jorge Díez
Contributions
Contributions
Abstract
Abstract: E1504
Type: Eposter Presentation
Background
Hodgkin´s Lymphoma (HL) is a potentially “curable malignant disease” with chemotherapy, radiotherapy or, eventually, high-dose chemotherapy followed by autologous stem cell transplantation (SCT). For patients relapsing after auto-SCT or those with advance refractory lymphoma, allogeneic SCT is a valid option. In this setting, our institution has opted for haploidentical donors as source of stem cells for allo-SCT in advanced HL patients.
Aims
Patients with advanced HL who received haploidentical SCT (haplo-SCT) were retrospectively analyzed in terms of overall survival (OS), progression-free survival (PFS) and graft versus host disease (GVHD).
Methods
From May 2012 to September 2015 eighteen haplo-SCT were performed at our hospital on patients with HL who had relapsed after auto-SCT or had needed more than three lines of chemotherapy to reach any kind of response. The conditioning regimen consisted of cyclophosphamide (Cy) 14.5 mg/Kg on days -6 and -5, fludarabine 30 mg/m2 on days -6 to -2 and busulfan (Bu) on days -3 and -2. GVHD prophylaxis consisted of Cy 50 mg/Kg on days +3 and +4, followed by tacrolimus plus mycophenolate mofetil from day +5.
Results
The median age of the cohort was 31 years (19-58). The HCT-CI > 2, EBMT score > 3 and high DR index were 28%, 67% and 11%, respectively. Thirty-nine percent of all patients were not in complete remission and eleven percent were in progression at the time of transplantation. The median number of treatment lines before SCT was five (4-11) and brentuximab-vedotin was employed as bridge to the allo-SCT in 44% of cases. Thirty-nine of the patients had received a previous autograft and one patient both, auto-SCT and allo-SCT. Median time to haplo-SCT from diagnosis was 42 months. The stem cell sources were bone marrow (22%) and peripheral blood (78%). All the patients engrafted and full donor chimerism was reached in 100% of the entire cohort at day +30. The median times to neutrophil (>0.5 x 10e9/L) and platelet recovery (>20 x10e 9/L) were 18 (13-30) and 26 (10-44) days from SCT. Extramedullary toxicity grade 3-4 occurred in 2 cases. One of them developed severe hepatic veno-occlusive disease which was resolved with defibrotide. Seventeen patients were evaluable for acute and chronic GVHD. The 100-day cumulative incidence (CI) of grade II-IV acute GVHD was 35% (7% grade III-IV) with a median time of 33 days (23-80). The cumulative 3-year incidence of moderate chronic GVHD was 13%. With a median follow-up of 14 months (range 2-44), the CI of non-relapse mortality (NRM) and of relapse were 5% (1/18) and 42% (6/18), respectively. The actuarial OS and PFS at 45 months was 77% and 57%, respectively. Fifteen patients are alive, 12 disease free. The causes of death were relapse (n=2) and BK virus encephalitis (n=1). Relapses are being treated with brentuximab-vedotin followed by donor lymphocyte infusions (DLI), with no cases of GVHD.
Conclusion
Haplo-SCT with Bu based RIC and high-dose post-transplantation Cy offers high rates of remission in advanced HL, with low incidence of GVHD and NRM. In our experience, retreatment with brentuximab-vedotin combined with DLI is well tolerated and a good option to manage relapses after haplo-SCT.
Session topic: E-poster
Keyword(s): Haploidentical stem cell transplantation, Hodgkin's lymphoma
Type: Eposter Presentation
Background
Hodgkin´s Lymphoma (HL) is a potentially “curable malignant disease” with chemotherapy, radiotherapy or, eventually, high-dose chemotherapy followed by autologous stem cell transplantation (SCT). For patients relapsing after auto-SCT or those with advance refractory lymphoma, allogeneic SCT is a valid option. In this setting, our institution has opted for haploidentical donors as source of stem cells for allo-SCT in advanced HL patients.
Aims
Patients with advanced HL who received haploidentical SCT (haplo-SCT) were retrospectively analyzed in terms of overall survival (OS), progression-free survival (PFS) and graft versus host disease (GVHD).
Methods
From May 2012 to September 2015 eighteen haplo-SCT were performed at our hospital on patients with HL who had relapsed after auto-SCT or had needed more than three lines of chemotherapy to reach any kind of response. The conditioning regimen consisted of cyclophosphamide (Cy) 14.5 mg/Kg on days -6 and -5, fludarabine 30 mg/m2 on days -6 to -2 and busulfan (Bu) on days -3 and -2. GVHD prophylaxis consisted of Cy 50 mg/Kg on days +3 and +4, followed by tacrolimus plus mycophenolate mofetil from day +5.
Results
The median age of the cohort was 31 years (19-58). The HCT-CI > 2, EBMT score > 3 and high DR index were 28%, 67% and 11%, respectively. Thirty-nine percent of all patients were not in complete remission and eleven percent were in progression at the time of transplantation. The median number of treatment lines before SCT was five (4-11) and brentuximab-vedotin was employed as bridge to the allo-SCT in 44% of cases. Thirty-nine of the patients had received a previous autograft and one patient both, auto-SCT and allo-SCT. Median time to haplo-SCT from diagnosis was 42 months. The stem cell sources were bone marrow (22%) and peripheral blood (78%). All the patients engrafted and full donor chimerism was reached in 100% of the entire cohort at day +30. The median times to neutrophil (>0.5 x 10e9/L) and platelet recovery (>20 x10e 9/L) were 18 (13-30) and 26 (10-44) days from SCT. Extramedullary toxicity grade 3-4 occurred in 2 cases. One of them developed severe hepatic veno-occlusive disease which was resolved with defibrotide. Seventeen patients were evaluable for acute and chronic GVHD. The 100-day cumulative incidence (CI) of grade II-IV acute GVHD was 35% (7% grade III-IV) with a median time of 33 days (23-80). The cumulative 3-year incidence of moderate chronic GVHD was 13%. With a median follow-up of 14 months (range 2-44), the CI of non-relapse mortality (NRM) and of relapse were 5% (1/18) and 42% (6/18), respectively. The actuarial OS and PFS at 45 months was 77% and 57%, respectively. Fifteen patients are alive, 12 disease free. The causes of death were relapse (n=2) and BK virus encephalitis (n=1). Relapses are being treated with brentuximab-vedotin followed by donor lymphocyte infusions (DLI), with no cases of GVHD.
Conclusion
Haplo-SCT with Bu based RIC and high-dose post-transplantation Cy offers high rates of remission in advanced HL, with low incidence of GVHD and NRM. In our experience, retreatment with brentuximab-vedotin combined with DLI is well tolerated and a good option to manage relapses after haplo-SCT.
Session topic: E-poster
Keyword(s): Haploidentical stem cell transplantation, Hodgkin's lymphoma
Abstract: E1504
Type: Eposter Presentation
Background
Hodgkin´s Lymphoma (HL) is a potentially “curable malignant disease” with chemotherapy, radiotherapy or, eventually, high-dose chemotherapy followed by autologous stem cell transplantation (SCT). For patients relapsing after auto-SCT or those with advance refractory lymphoma, allogeneic SCT is a valid option. In this setting, our institution has opted for haploidentical donors as source of stem cells for allo-SCT in advanced HL patients.
Aims
Patients with advanced HL who received haploidentical SCT (haplo-SCT) were retrospectively analyzed in terms of overall survival (OS), progression-free survival (PFS) and graft versus host disease (GVHD).
Methods
From May 2012 to September 2015 eighteen haplo-SCT were performed at our hospital on patients with HL who had relapsed after auto-SCT or had needed more than three lines of chemotherapy to reach any kind of response. The conditioning regimen consisted of cyclophosphamide (Cy) 14.5 mg/Kg on days -6 and -5, fludarabine 30 mg/m2 on days -6 to -2 and busulfan (Bu) on days -3 and -2. GVHD prophylaxis consisted of Cy 50 mg/Kg on days +3 and +4, followed by tacrolimus plus mycophenolate mofetil from day +5.
Results
The median age of the cohort was 31 years (19-58). The HCT-CI > 2, EBMT score > 3 and high DR index were 28%, 67% and 11%, respectively. Thirty-nine percent of all patients were not in complete remission and eleven percent were in progression at the time of transplantation. The median number of treatment lines before SCT was five (4-11) and brentuximab-vedotin was employed as bridge to the allo-SCT in 44% of cases. Thirty-nine of the patients had received a previous autograft and one patient both, auto-SCT and allo-SCT. Median time to haplo-SCT from diagnosis was 42 months. The stem cell sources were bone marrow (22%) and peripheral blood (78%). All the patients engrafted and full donor chimerism was reached in 100% of the entire cohort at day +30. The median times to neutrophil (>0.5 x 10e9/L) and platelet recovery (>20 x10e 9/L) were 18 (13-30) and 26 (10-44) days from SCT. Extramedullary toxicity grade 3-4 occurred in 2 cases. One of them developed severe hepatic veno-occlusive disease which was resolved with defibrotide. Seventeen patients were evaluable for acute and chronic GVHD. The 100-day cumulative incidence (CI) of grade II-IV acute GVHD was 35% (7% grade III-IV) with a median time of 33 days (23-80). The cumulative 3-year incidence of moderate chronic GVHD was 13%. With a median follow-up of 14 months (range 2-44), the CI of non-relapse mortality (NRM) and of relapse were 5% (1/18) and 42% (6/18), respectively. The actuarial OS and PFS at 45 months was 77% and 57%, respectively. Fifteen patients are alive, 12 disease free. The causes of death were relapse (n=2) and BK virus encephalitis (n=1). Relapses are being treated with brentuximab-vedotin followed by donor lymphocyte infusions (DLI), with no cases of GVHD.
Conclusion
Haplo-SCT with Bu based RIC and high-dose post-transplantation Cy offers high rates of remission in advanced HL, with low incidence of GVHD and NRM. In our experience, retreatment with brentuximab-vedotin combined with DLI is well tolerated and a good option to manage relapses after haplo-SCT.
Session topic: E-poster
Keyword(s): Haploidentical stem cell transplantation, Hodgkin's lymphoma
Type: Eposter Presentation
Background
Hodgkin´s Lymphoma (HL) is a potentially “curable malignant disease” with chemotherapy, radiotherapy or, eventually, high-dose chemotherapy followed by autologous stem cell transplantation (SCT). For patients relapsing after auto-SCT or those with advance refractory lymphoma, allogeneic SCT is a valid option. In this setting, our institution has opted for haploidentical donors as source of stem cells for allo-SCT in advanced HL patients.
Aims
Patients with advanced HL who received haploidentical SCT (haplo-SCT) were retrospectively analyzed in terms of overall survival (OS), progression-free survival (PFS) and graft versus host disease (GVHD).
Methods
From May 2012 to September 2015 eighteen haplo-SCT were performed at our hospital on patients with HL who had relapsed after auto-SCT or had needed more than three lines of chemotherapy to reach any kind of response. The conditioning regimen consisted of cyclophosphamide (Cy) 14.5 mg/Kg on days -6 and -5, fludarabine 30 mg/m2 on days -6 to -2 and busulfan (Bu) on days -3 and -2. GVHD prophylaxis consisted of Cy 50 mg/Kg on days +3 and +4, followed by tacrolimus plus mycophenolate mofetil from day +5.
Results
The median age of the cohort was 31 years (19-58). The HCT-CI > 2, EBMT score > 3 and high DR index were 28%, 67% and 11%, respectively. Thirty-nine percent of all patients were not in complete remission and eleven percent were in progression at the time of transplantation. The median number of treatment lines before SCT was five (4-11) and brentuximab-vedotin was employed as bridge to the allo-SCT in 44% of cases. Thirty-nine of the patients had received a previous autograft and one patient both, auto-SCT and allo-SCT. Median time to haplo-SCT from diagnosis was 42 months. The stem cell sources were bone marrow (22%) and peripheral blood (78%). All the patients engrafted and full donor chimerism was reached in 100% of the entire cohort at day +30. The median times to neutrophil (>0.5 x 10e9/L) and platelet recovery (>20 x10e 9/L) were 18 (13-30) and 26 (10-44) days from SCT. Extramedullary toxicity grade 3-4 occurred in 2 cases. One of them developed severe hepatic veno-occlusive disease which was resolved with defibrotide. Seventeen patients were evaluable for acute and chronic GVHD. The 100-day cumulative incidence (CI) of grade II-IV acute GVHD was 35% (7% grade III-IV) with a median time of 33 days (23-80). The cumulative 3-year incidence of moderate chronic GVHD was 13%. With a median follow-up of 14 months (range 2-44), the CI of non-relapse mortality (NRM) and of relapse were 5% (1/18) and 42% (6/18), respectively. The actuarial OS and PFS at 45 months was 77% and 57%, respectively. Fifteen patients are alive, 12 disease free. The causes of death were relapse (n=2) and BK virus encephalitis (n=1). Relapses are being treated with brentuximab-vedotin followed by donor lymphocyte infusions (DLI), with no cases of GVHD.
Conclusion
Haplo-SCT with Bu based RIC and high-dose post-transplantation Cy offers high rates of remission in advanced HL, with low incidence of GVHD and NRM. In our experience, retreatment with brentuximab-vedotin combined with DLI is well tolerated and a good option to manage relapses after haplo-SCT.
Session topic: E-poster
Keyword(s): Haploidentical stem cell transplantation, Hodgkin's lymphoma
{{ help_message }}
{{filter}}