ALLOGENEIC STEM CELL TRANSPLANTATION AND BRENTUXIMAB VEDOTIN IN RELAPSED/REFRACTORY HODGKIN LYMPHOMA: A MULTICENTER EXPERIENCE
(Abstract release date: 05/19/16)
EHA Library. Festuccia M. 06/12/16; 135290; S796
Dr. Moreno Benedetto Festuccia
Contributions
Contributions
Abstract
Abstract: S796
Type: Oral Presentation
Presentation during EHA21: On Sunday, June 12, 2016 from 08:45 - 09:00
Location: Hall A2
Background
Patients with relapsed/refractory (RR) Hodgkin lymphoma (HL) have a very poor prognosis. Allogeneic stem cell transplantation (allo-HCT) has been used in this setting with controversial results.
Aims
Aim of our study is to investigate the role of allo-HCT in RR HL.
Methods
This study reported on 69 patients with RR HL, median age 34 (range, 18 - 64), consecutively transplanted between 2000 and 2015 in 3 transplant center in Northwest Italy. Coordinator of the project was the Division of Hematology of the University of Torino. Patients were heavily pre-treated with a median of 4 therapy lines (range, 2 - 6). Sixty-four patients (93%) received previous high-dose chemotherapy and autologous transplantation.At the time of allo-HCT, 52 patients (75%) were at least in partial remission (PR) and were defined responsive. The remaining 16 patients (23%) had progressive disease (non-responsive). The disease status of 1 patient was not available. Brentuximab Vedotin (BV) was given as bridge to transplant in 11 patients. Moreover, 7 patients received BV after allo-HCT as salvage.The majority of patients underwent reduced intensity allo-HCT, 64 patients (93%). Donors were HLA-matched unrelated in 39 cases (57%), HLA-matched siblings in 28 cases (41%), HLA-haploidentical in 2 cases (3%). The stem cells source was peripheral blood in 61 patients (88%), bone marrow in 7 patients (10%) and cord blood in 1 patient (1%).
Results
Overall, 32 patients (46%) have died at the time of last contact, including 20 patients who had relapsed. This resulted in a median overall survival (OS) [Figure 1], and relapse-free survival (RFS) of 5.1 years (range, 0 - 13.8), and 1.3 years (range, 0 – 12.6), respectively. Median follow-up among the 37 survivors was 7.2 years (range, 0.1 – 13.8). The 5-year cumulative incidence of treatment related mortality (TRM) and relapse were 17.7% and 43.4%, respectively. As expected, patients younger than 35 had a lower 5-year TRM compared to older patients (8.7% versus 27.1%). The day-100 cumulative incidence of grades II-IV acute graft-versus-host disease (GvHD) was 36.7% (60 evaluable patients). Only 8 patients had grade III disease. No grade IV acute GvHD was reported. The cumulative incidence of limited or extensive chronic GvHD was 45.6% (57 evaluable patients).The 5-year estimated of RFS was significantly higher in responsive compared to non-responsive patients, 46.9% versus 12.5%, respectively, p= 0.009. There was a trend to improved 5-year OS in responsive patients, 54.6% versus 37.5%, respectively, p= 0.19. The RFS advantage of responsive patients was confirmed by multivariable Cox regression (HR= 3, 95% CI 1.4 - 6.4, p= 0.005). The 5-year relapse incidence was 35.3% and 68.8% in responsive and non-responsive patients, respectively.Eleven patients received BV as bridge to allo-HCT for a median of 6 cycles. Only 3 patients failed to achieved at least PR. Then, BV was used as salvage for post-alloHCT relapse in 7 patients. All patients achieved at least PR. None of patients treated with BV had unexpected toxicity or GVHD worsening.
Conclusion
Allo-HCT is a feasible and effective option for RR HL. In our series, the disease status at HCT was the main predictor of outcomes, primarily relapse. Furthermore, BV showed efficacy as a bridge to allo-HCT as well as post allo-HCT rescue.
Session topic: Relapsed Hodgkin Lymphoma & Primary Mediastinal Large B-Cell Lymphoma (PM-DLBCL)
Keyword(s): Allogeneic hematopoietic stem cell transplant, Hodgkin's lymphoma
Type: Oral Presentation
Presentation during EHA21: On Sunday, June 12, 2016 from 08:45 - 09:00
Location: Hall A2
Background
Patients with relapsed/refractory (RR) Hodgkin lymphoma (HL) have a very poor prognosis. Allogeneic stem cell transplantation (allo-HCT) has been used in this setting with controversial results.
Aims
Aim of our study is to investigate the role of allo-HCT in RR HL.
Methods
This study reported on 69 patients with RR HL, median age 34 (range, 18 - 64), consecutively transplanted between 2000 and 2015 in 3 transplant center in Northwest Italy. Coordinator of the project was the Division of Hematology of the University of Torino. Patients were heavily pre-treated with a median of 4 therapy lines (range, 2 - 6). Sixty-four patients (93%) received previous high-dose chemotherapy and autologous transplantation.At the time of allo-HCT, 52 patients (75%) were at least in partial remission (PR) and were defined responsive. The remaining 16 patients (23%) had progressive disease (non-responsive). The disease status of 1 patient was not available. Brentuximab Vedotin (BV) was given as bridge to transplant in 11 patients. Moreover, 7 patients received BV after allo-HCT as salvage.The majority of patients underwent reduced intensity allo-HCT, 64 patients (93%). Donors were HLA-matched unrelated in 39 cases (57%), HLA-matched siblings in 28 cases (41%), HLA-haploidentical in 2 cases (3%). The stem cells source was peripheral blood in 61 patients (88%), bone marrow in 7 patients (10%) and cord blood in 1 patient (1%).
Results
Overall, 32 patients (46%) have died at the time of last contact, including 20 patients who had relapsed. This resulted in a median overall survival (OS) [Figure 1], and relapse-free survival (RFS) of 5.1 years (range, 0 - 13.8), and 1.3 years (range, 0 – 12.6), respectively. Median follow-up among the 37 survivors was 7.2 years (range, 0.1 – 13.8). The 5-year cumulative incidence of treatment related mortality (TRM) and relapse were 17.7% and 43.4%, respectively. As expected, patients younger than 35 had a lower 5-year TRM compared to older patients (8.7% versus 27.1%). The day-100 cumulative incidence of grades II-IV acute graft-versus-host disease (GvHD) was 36.7% (60 evaluable patients). Only 8 patients had grade III disease. No grade IV acute GvHD was reported. The cumulative incidence of limited or extensive chronic GvHD was 45.6% (57 evaluable patients).The 5-year estimated of RFS was significantly higher in responsive compared to non-responsive patients, 46.9% versus 12.5%, respectively, p= 0.009. There was a trend to improved 5-year OS in responsive patients, 54.6% versus 37.5%, respectively, p= 0.19. The RFS advantage of responsive patients was confirmed by multivariable Cox regression (HR= 3, 95% CI 1.4 - 6.4, p= 0.005). The 5-year relapse incidence was 35.3% and 68.8% in responsive and non-responsive patients, respectively.Eleven patients received BV as bridge to allo-HCT for a median of 6 cycles. Only 3 patients failed to achieved at least PR. Then, BV was used as salvage for post-alloHCT relapse in 7 patients. All patients achieved at least PR. None of patients treated with BV had unexpected toxicity or GVHD worsening.
Conclusion
Allo-HCT is a feasible and effective option for RR HL. In our series, the disease status at HCT was the main predictor of outcomes, primarily relapse. Furthermore, BV showed efficacy as a bridge to allo-HCT as well as post allo-HCT rescue.
Session topic: Relapsed Hodgkin Lymphoma & Primary Mediastinal Large B-Cell Lymphoma (PM-DLBCL)
Keyword(s): Allogeneic hematopoietic stem cell transplant, Hodgkin's lymphoma
Abstract: S796
Type: Oral Presentation
Presentation during EHA21: On Sunday, June 12, 2016 from 08:45 - 09:00
Location: Hall A2
Background
Patients with relapsed/refractory (RR) Hodgkin lymphoma (HL) have a very poor prognosis. Allogeneic stem cell transplantation (allo-HCT) has been used in this setting with controversial results.
Aims
Aim of our study is to investigate the role of allo-HCT in RR HL.
Methods
This study reported on 69 patients with RR HL, median age 34 (range, 18 - 64), consecutively transplanted between 2000 and 2015 in 3 transplant center in Northwest Italy. Coordinator of the project was the Division of Hematology of the University of Torino. Patients were heavily pre-treated with a median of 4 therapy lines (range, 2 - 6). Sixty-four patients (93%) received previous high-dose chemotherapy and autologous transplantation.At the time of allo-HCT, 52 patients (75%) were at least in partial remission (PR) and were defined responsive. The remaining 16 patients (23%) had progressive disease (non-responsive). The disease status of 1 patient was not available. Brentuximab Vedotin (BV) was given as bridge to transplant in 11 patients. Moreover, 7 patients received BV after allo-HCT as salvage.The majority of patients underwent reduced intensity allo-HCT, 64 patients (93%). Donors were HLA-matched unrelated in 39 cases (57%), HLA-matched siblings in 28 cases (41%), HLA-haploidentical in 2 cases (3%). The stem cells source was peripheral blood in 61 patients (88%), bone marrow in 7 patients (10%) and cord blood in 1 patient (1%).
Results
Overall, 32 patients (46%) have died at the time of last contact, including 20 patients who had relapsed. This resulted in a median overall survival (OS) [Figure 1], and relapse-free survival (RFS) of 5.1 years (range, 0 - 13.8), and 1.3 years (range, 0 – 12.6), respectively. Median follow-up among the 37 survivors was 7.2 years (range, 0.1 – 13.8). The 5-year cumulative incidence of treatment related mortality (TRM) and relapse were 17.7% and 43.4%, respectively. As expected, patients younger than 35 had a lower 5-year TRM compared to older patients (8.7% versus 27.1%). The day-100 cumulative incidence of grades II-IV acute graft-versus-host disease (GvHD) was 36.7% (60 evaluable patients). Only 8 patients had grade III disease. No grade IV acute GvHD was reported. The cumulative incidence of limited or extensive chronic GvHD was 45.6% (57 evaluable patients).The 5-year estimated of RFS was significantly higher in responsive compared to non-responsive patients, 46.9% versus 12.5%, respectively, p= 0.009. There was a trend to improved 5-year OS in responsive patients, 54.6% versus 37.5%, respectively, p= 0.19. The RFS advantage of responsive patients was confirmed by multivariable Cox regression (HR= 3, 95% CI 1.4 - 6.4, p= 0.005). The 5-year relapse incidence was 35.3% and 68.8% in responsive and non-responsive patients, respectively.Eleven patients received BV as bridge to allo-HCT for a median of 6 cycles. Only 3 patients failed to achieved at least PR. Then, BV was used as salvage for post-alloHCT relapse in 7 patients. All patients achieved at least PR. None of patients treated with BV had unexpected toxicity or GVHD worsening.
Conclusion
Allo-HCT is a feasible and effective option for RR HL. In our series, the disease status at HCT was the main predictor of outcomes, primarily relapse. Furthermore, BV showed efficacy as a bridge to allo-HCT as well as post allo-HCT rescue.
Session topic: Relapsed Hodgkin Lymphoma & Primary Mediastinal Large B-Cell Lymphoma (PM-DLBCL)
Keyword(s): Allogeneic hematopoietic stem cell transplant, Hodgkin's lymphoma
Type: Oral Presentation
Presentation during EHA21: On Sunday, June 12, 2016 from 08:45 - 09:00
Location: Hall A2
Background
Patients with relapsed/refractory (RR) Hodgkin lymphoma (HL) have a very poor prognosis. Allogeneic stem cell transplantation (allo-HCT) has been used in this setting with controversial results.
Aims
Aim of our study is to investigate the role of allo-HCT in RR HL.
Methods
This study reported on 69 patients with RR HL, median age 34 (range, 18 - 64), consecutively transplanted between 2000 and 2015 in 3 transplant center in Northwest Italy. Coordinator of the project was the Division of Hematology of the University of Torino. Patients were heavily pre-treated with a median of 4 therapy lines (range, 2 - 6). Sixty-four patients (93%) received previous high-dose chemotherapy and autologous transplantation.At the time of allo-HCT, 52 patients (75%) were at least in partial remission (PR) and were defined responsive. The remaining 16 patients (23%) had progressive disease (non-responsive). The disease status of 1 patient was not available. Brentuximab Vedotin (BV) was given as bridge to transplant in 11 patients. Moreover, 7 patients received BV after allo-HCT as salvage.The majority of patients underwent reduced intensity allo-HCT, 64 patients (93%). Donors were HLA-matched unrelated in 39 cases (57%), HLA-matched siblings in 28 cases (41%), HLA-haploidentical in 2 cases (3%). The stem cells source was peripheral blood in 61 patients (88%), bone marrow in 7 patients (10%) and cord blood in 1 patient (1%).
Results
Overall, 32 patients (46%) have died at the time of last contact, including 20 patients who had relapsed. This resulted in a median overall survival (OS) [Figure 1], and relapse-free survival (RFS) of 5.1 years (range, 0 - 13.8), and 1.3 years (range, 0 – 12.6), respectively. Median follow-up among the 37 survivors was 7.2 years (range, 0.1 – 13.8). The 5-year cumulative incidence of treatment related mortality (TRM) and relapse were 17.7% and 43.4%, respectively. As expected, patients younger than 35 had a lower 5-year TRM compared to older patients (8.7% versus 27.1%). The day-100 cumulative incidence of grades II-IV acute graft-versus-host disease (GvHD) was 36.7% (60 evaluable patients). Only 8 patients had grade III disease. No grade IV acute GvHD was reported. The cumulative incidence of limited or extensive chronic GvHD was 45.6% (57 evaluable patients).The 5-year estimated of RFS was significantly higher in responsive compared to non-responsive patients, 46.9% versus 12.5%, respectively, p= 0.009. There was a trend to improved 5-year OS in responsive patients, 54.6% versus 37.5%, respectively, p= 0.19. The RFS advantage of responsive patients was confirmed by multivariable Cox regression (HR= 3, 95% CI 1.4 - 6.4, p= 0.005). The 5-year relapse incidence was 35.3% and 68.8% in responsive and non-responsive patients, respectively.Eleven patients received BV as bridge to allo-HCT for a median of 6 cycles. Only 3 patients failed to achieved at least PR. Then, BV was used as salvage for post-alloHCT relapse in 7 patients. All patients achieved at least PR. None of patients treated with BV had unexpected toxicity or GVHD worsening.
Conclusion
Allo-HCT is a feasible and effective option for RR HL. In our series, the disease status at HCT was the main predictor of outcomes, primarily relapse. Furthermore, BV showed efficacy as a bridge to allo-HCT as well as post allo-HCT rescue.
Session topic: Relapsed Hodgkin Lymphoma & Primary Mediastinal Large B-Cell Lymphoma (PM-DLBCL)
Keyword(s): Allogeneic hematopoietic stem cell transplant, Hodgkin's lymphoma
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