Contributions
Abstract: S127
Type: Oral Presentation
Presentation during EHA23: On Friday, June 15, 2018 from 12:15 - 12:30
Location: Room A6
Background
Both autologous (auto-HSCT) and allogeneic stem cell transplantation (allo-HSCT) represent well-accepted treatment strategies for patients with relapsed / refractory (RR) Hodgkin lymphoma (HL). Nevertheless, both transplant modalities have evolved over time and the recent advent of new drugs might have modified the indications and timing of HSCT.
Aims
We have therefore analysed the transplant activity for patients with RR HL reported to the EBMT registry over the last three decades.
Methods
Patients were included if they had RR (primary refractory or relapsed disease) HL, were above 18 years of age and had undergone an auto-HSCT as 1st HSCT or an allo-HSCT either as a 1st HSCT or after a prior auto-HSCT between January 1990 to December 2014. Med A level data were retrieved from the EBMT database.
Results
13639 patients [11435 auto-HSCT and 2204 allo-HSCT (555 1st allo-HSCT and 1649 allo-HSCT after an auto-HSCT)] were registered in the EBMT database during the study period. The number of auto-HSCT steadily increased from 129 in 1990 up to a maximum of 811 in 2010; the number of allo-HSCT also increased from 6 in 1990 up to a peak of 243 in 2014. With regards to autologous recipients, over time there was a significant increase in age at HSCT [31 yrs (1990-1994) vs 35 yrs (2010-2014), p<0.0001], time between diagnosis and HSCT was shorter [31 (1990-1994) vs 23 mo (2010-2014), p<0.0001], peripheral blood (PB) has become the universally used stem cell source [30% (1990-1994] vs 98% (2010-2014), p<0.0001] and total body irradiation has almost been abandoned [4% (1990-1994) vs 1.7% (2010-2014), p<0.0001]. 36-mo overall survival (OS) has significantly improved over time [63% (1990-1994) vs 79% (2010-2014), p<0.0001] as well as non-relapse mortality (NRM) [12% (1990-12994) vs 6% (2010-2014), p<0.0001]. Interestingly, allo-HSCT has been less used as the 1st HSCT [88% (1990-1994) vs 23% (2010-1014)] whereas the number of allo-HSCT after a first auto-HSCT has steadily increased [12% (1990-1994) vs 77% (2010-2014), p<0.0001]. Time between diagnosis and HSCT has decreased over time also in allogeneic recipients [36 mo (1990-1994) vs 34 mo (2010-2014), p<0.04]]. Performance status >80% at HSCT has improved [62% (1990-1994) vs 94% (2010-2014), p<0.0001], PB has become the universal source of stem cells [6% (1990-1994) vs 84% (2010-2014), p<0.0001], and there has been a more frequent use of reduced intensity conditioning protocols [0% (1990-1994) vs 70% (2010-2014), p<0.0001] as well as of matched unrelated donors and haploidentical donors [0% (1990-1994) vs 48% (2010-2014) and 0% (1990-1994) vs 17% (2010-2014), respectively, p<0.0001]. 36-month OS estimates have also significantly improved [21% (1990-1994) vs 61% (2010-2014), p<0.001)] as well as those for progression free survival [15% (1990-1994) vs 43% (2010-2014), p<0.001] and NRM [58% (1990-1994) vs 22% (2010-2014), p<0.001].
Conclusion
Transplantation activity, the clinical pattern of patients undergoing this treatment and the characteristics of the procedure have significantly changed over the study period and results in terms of OS and NRM for both auto-HSCT and allo-HSCT are much better. Improvement of supportive measures as well as in the experience of the transplant centers and a better selection of patients could account for these changes. The impact of the introduction of new treatment modalities (anti-CD30 monoclonal antibodies, check point inhibitors) in the number of HSCT is difficult to ascertain at this point.
Session topic: 23. Stem cell transplantation - Clinical
Keyword(s): Hodgkin's Lymphoma, Stem cell transplant
Abstract: S127
Type: Oral Presentation
Presentation during EHA23: On Friday, June 15, 2018 from 12:15 - 12:30
Location: Room A6
Background
Both autologous (auto-HSCT) and allogeneic stem cell transplantation (allo-HSCT) represent well-accepted treatment strategies for patients with relapsed / refractory (RR) Hodgkin lymphoma (HL). Nevertheless, both transplant modalities have evolved over time and the recent advent of new drugs might have modified the indications and timing of HSCT.
Aims
We have therefore analysed the transplant activity for patients with RR HL reported to the EBMT registry over the last three decades.
Methods
Patients were included if they had RR (primary refractory or relapsed disease) HL, were above 18 years of age and had undergone an auto-HSCT as 1st HSCT or an allo-HSCT either as a 1st HSCT or after a prior auto-HSCT between January 1990 to December 2014. Med A level data were retrieved from the EBMT database.
Results
13639 patients [11435 auto-HSCT and 2204 allo-HSCT (555 1st allo-HSCT and 1649 allo-HSCT after an auto-HSCT)] were registered in the EBMT database during the study period. The number of auto-HSCT steadily increased from 129 in 1990 up to a maximum of 811 in 2010; the number of allo-HSCT also increased from 6 in 1990 up to a peak of 243 in 2014. With regards to autologous recipients, over time there was a significant increase in age at HSCT [31 yrs (1990-1994) vs 35 yrs (2010-2014), p<0.0001], time between diagnosis and HSCT was shorter [31 (1990-1994) vs 23 mo (2010-2014), p<0.0001], peripheral blood (PB) has become the universally used stem cell source [30% (1990-1994] vs 98% (2010-2014), p<0.0001] and total body irradiation has almost been abandoned [4% (1990-1994) vs 1.7% (2010-2014), p<0.0001]. 36-mo overall survival (OS) has significantly improved over time [63% (1990-1994) vs 79% (2010-2014), p<0.0001] as well as non-relapse mortality (NRM) [12% (1990-12994) vs 6% (2010-2014), p<0.0001]. Interestingly, allo-HSCT has been less used as the 1st HSCT [88% (1990-1994) vs 23% (2010-1014)] whereas the number of allo-HSCT after a first auto-HSCT has steadily increased [12% (1990-1994) vs 77% (2010-2014), p<0.0001]. Time between diagnosis and HSCT has decreased over time also in allogeneic recipients [36 mo (1990-1994) vs 34 mo (2010-2014), p<0.04]]. Performance status >80% at HSCT has improved [62% (1990-1994) vs 94% (2010-2014), p<0.0001], PB has become the universal source of stem cells [6% (1990-1994) vs 84% (2010-2014), p<0.0001], and there has been a more frequent use of reduced intensity conditioning protocols [0% (1990-1994) vs 70% (2010-2014), p<0.0001] as well as of matched unrelated donors and haploidentical donors [0% (1990-1994) vs 48% (2010-2014) and 0% (1990-1994) vs 17% (2010-2014), respectively, p<0.0001]. 36-month OS estimates have also significantly improved [21% (1990-1994) vs 61% (2010-2014), p<0.001)] as well as those for progression free survival [15% (1990-1994) vs 43% (2010-2014), p<0.001] and NRM [58% (1990-1994) vs 22% (2010-2014), p<0.001].
Conclusion
Transplantation activity, the clinical pattern of patients undergoing this treatment and the characteristics of the procedure have significantly changed over the study period and results in terms of OS and NRM for both auto-HSCT and allo-HSCT are much better. Improvement of supportive measures as well as in the experience of the transplant centers and a better selection of patients could account for these changes. The impact of the introduction of new treatment modalities (anti-CD30 monoclonal antibodies, check point inhibitors) in the number of HSCT is difficult to ascertain at this point.
Session topic: 23. Stem cell transplantation - Clinical
Keyword(s): Hodgkin's Lymphoma, Stem cell transplant