THE MANAGEMENT OF RELAPSED HODGKIN´S LYMPHOMA AFTER HAPLOIDENTICAL STEM CELL TRANSPLANTATION: DONNOR LYMPHOCYTE INFUSION AND BRENTUXIMAB.
(Abstract release date: 05/18/17)
EHA Library. Sánchez Bazán I. 05/18/17; 182873; PB2160
Dra Irene Sánchez Bazán
Contributions
Contributions
Abstract
Abstract: PB2160
Type: Publication Only
Background
Hodgkin's lymphoma, is an heterogeneous malignancy wich is posible to cure. For those patients who relapse, chemotherapy followed by an autologous transplantation (autoTPH) may conduce to a complete remission. Allogeneic transplantation (alo-SCT) is used for patients in relapse after auto-SCT or those with refractory advanced disease. Since 2012, with the experience of the Baltimore group, our Center has chosen the haploidentical family donor as a source for aloSCT in Hodgkin's disease. Despite the promising results, the rate of relapse is between 25 and 35%, and there is not standardized treatment for this situation.
Aims
To analyze the outcome of post-transplant relapse treatment of haploident donor haematopoietic progenitors (haploTPH).
Methods
We studied 18 patients with the diagnose of Hodgkins lymphoma in our center between August 2004 and July of 2013. All of them were submitted to haploSCT with a median follow-up of 495 days (455-1054)
Results
The median age was 32 years (21-60). 44% (8 patients) relapsed. 60% of then (5 patients) were nodular sclerosis histological subtype and 40% (3) lifocitic predominance. 2 patients (25%) were diagnosed in stage IV and 75% (6) stage II. The median of number of treatment lines received before transplantation was 5.5 (4-7); Compared to 7 in the non-relapsed group (4-11). 5 patients (60%) of the patients who relapsed had reached haploTPH in complete remission and 40% in partial remission, we did not observe differences related to the pre-SCT status.
Peripheral blood was used as progenitors source in 75% (6) of the patients who relapsed and in 70% (7) in the non-relapsed group. 38% of the whole group of patients, had a donor/recipient KIR alloreactivity without differences between the two groups of the study. 88% (7) of the relapses occurred before 6 months of the SCT. The mean time to relapse was 316 days (range 181-446).
Between the 8 relapsed patients, one was treated by another center with Vimblastine / Dexamethasone and died by infection, another patient died by abdominal sepsis before starting any treatment.
Brentuximab was administered in 63% (5) of the patients. One of them received a single Brentuximab cycle with no tolerance, and changed to RT, GPD + Donnor lymphocyte infusions (DLI) and had reached complete response after 5 DLI. The rest (4) received between 3 and 7 doses with adequate tolerance. According to the the re-evaluation (PET-TC) after 3rd Brentuximab, 4 were in partial remission and one reached complete response.
We associated Donor lymphocyte infusion in 6 patients. The mean of DLI received was 10; the median was 8, with a range between 22-3. Four patients reached complete remission, two of them maintain a partial response. All of them presented good tolerance to DLI. We observed Graft versus host disease in four patients, 3 of them presented moderate cutaneous affection, and one of them suffered hepatic graft versus host disease stage III, with adequate evolution after treatment.
Conclusion
CONCLUSIONS: Is posible to treat patients who relapsed after haploidentical stem cell transplantation with Brentuximab + DLI, with a very good tolerance. We observed cutaneous graft versus host disease in most of the patients who reached completed response after DLI. Despite this findings, we need multicentric studies to perform standarized treatments and protocols.
Session topic: 22. Stem cell transplantation - Clinical
Keyword(s): Relapsed lymphoma, Hodgkin's Lymphoma, Haploidentical stem cell transplantation, Donor lymphocyte infusion
Abstract: PB2160
Type: Publication Only
Background
Hodgkin's lymphoma, is an heterogeneous malignancy wich is posible to cure. For those patients who relapse, chemotherapy followed by an autologous transplantation (autoTPH) may conduce to a complete remission. Allogeneic transplantation (alo-SCT) is used for patients in relapse after auto-SCT or those with refractory advanced disease. Since 2012, with the experience of the Baltimore group, our Center has chosen the haploidentical family donor as a source for aloSCT in Hodgkin's disease. Despite the promising results, the rate of relapse is between 25 and 35%, and there is not standardized treatment for this situation.
Aims
To analyze the outcome of post-transplant relapse treatment of haploident donor haematopoietic progenitors (haploTPH).
Methods
We studied 18 patients with the diagnose of Hodgkins lymphoma in our center between August 2004 and July of 2013. All of them were submitted to haploSCT with a median follow-up of 495 days (455-1054)
Results
The median age was 32 years (21-60). 44% (8 patients) relapsed. 60% of then (5 patients) were nodular sclerosis histological subtype and 40% (3) lifocitic predominance. 2 patients (25%) were diagnosed in stage IV and 75% (6) stage II. The median of number of treatment lines received before transplantation was 5.5 (4-7); Compared to 7 in the non-relapsed group (4-11). 5 patients (60%) of the patients who relapsed had reached haploTPH in complete remission and 40% in partial remission, we did not observe differences related to the pre-SCT status.
Peripheral blood was used as progenitors source in 75% (6) of the patients who relapsed and in 70% (7) in the non-relapsed group. 38% of the whole group of patients, had a donor/recipient KIR alloreactivity without differences between the two groups of the study. 88% (7) of the relapses occurred before 6 months of the SCT. The mean time to relapse was 316 days (range 181-446).
Between the 8 relapsed patients, one was treated by another center with Vimblastine / Dexamethasone and died by infection, another patient died by abdominal sepsis before starting any treatment.
Brentuximab was administered in 63% (5) of the patients. One of them received a single Brentuximab cycle with no tolerance, and changed to RT, GPD + Donnor lymphocyte infusions (DLI) and had reached complete response after 5 DLI. The rest (4) received between 3 and 7 doses with adequate tolerance. According to the the re-evaluation (PET-TC) after 3rd Brentuximab, 4 were in partial remission and one reached complete response.
We associated Donor lymphocyte infusion in 6 patients. The mean of DLI received was 10; the median was 8, with a range between 22-3. Four patients reached complete remission, two of them maintain a partial response. All of them presented good tolerance to DLI. We observed Graft versus host disease in four patients, 3 of them presented moderate cutaneous affection, and one of them suffered hepatic graft versus host disease stage III, with adequate evolution after treatment.
Conclusion
CONCLUSIONS: Is posible to treat patients who relapsed after haploidentical stem cell transplantation with Brentuximab + DLI, with a very good tolerance. We observed cutaneous graft versus host disease in most of the patients who reached completed response after DLI. Despite this findings, we need multicentric studies to perform standarized treatments and protocols.
Session topic: 22. Stem cell transplantation - Clinical
Keyword(s): Relapsed lymphoma, Hodgkin's Lymphoma, Haploidentical stem cell transplantation, Donor lymphocyte infusion
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