Contributions
Abstract: EP1288
Type: E-Poster Presentation
Session title: Stem cell transplantation - Clinical
Background
Allogeneic hematopoietic cell transplantation (Allo-HCT) is a potentially curative treatment for patients with relapsed/refractory (R/R) lymphomas. Patients with R/R lymphomas usually reach allo-HCT after several lines of treatment and are often affected by comorbidities. Therefore, these patients are often unsuitable for high intensity myeloablative conditioning regimen. Historically, reduced intensity conditioning (RIC) regimens are feasible in this subset of patients, but they are complicated by high rate of graft versus host disease (GvHD) and disease relapse. The more recent introduction of post-transplant cyclophosphamide (PT-Cy) for GvHD prophylaxis reduced acute and chronic GvHD rates and transplant-related mortality (TRM) in comparison to allo-HCT with conventional immune suppressive (IS) regimens. In particular, haploidentical (haplo) allo-HCT with PT-Cy showed acceptable rate of TRM and good progression free survival (PFS) in Hodgkin lymphoma patients (Castagna et al 2017). We have recently introduced total body irradiation (TBI)-based RIC followed by PT-Cy for R/R lymphoma patients. We adopted such strategy across all the different donor/recipient HLA-matching combinations.
Aims
To evaluate safety and feasibility of TBI-based RIC allo-HCT followed by PT-Cy prophylaxis for R/R lymphoma patients at our center.
Methods
We adopted TBI-based RIC allo-HCT followed by PT-Cy for R/R lymphoma patients starting in April 2016. We collected data until December 2020. Conditioning regimen to transplant was based on fludarabine (150mg/m2 in 5 days) and cyclophosphamide (14.5 mg/kg for 2 days) followed by TBI (2-4 Gy). PT-Cy dose was 50mg/kg for 2 days at day 3 and 4 after allo-HCT. GvHD prophylaxis consisted also of Tacrolimus and Mycophenolate Mofetil in patients with matched unrelated donors (MUD) or haplo donors (haplo) and Cyclosporine alone in patients with matched related donors (MRD).
Results
Since April 2016 we transplanted 27 patients with R/R lymphoma using TBI-based reduced-intensity conditioning and PT-Cy based GvHD prophylaxis. Median age at transplant was 48 years (range 25-62). Median number of previous lines of therapy was 5. Thirteen patients were affected by Hodgkin Lymphoma and 14 by Non-Hodgkin Lymphoma (7 B lymphomas, 7 T lymphomas). Twelve patients were transplanted in hematological complete remission, while 15 had active disease at transplant. All but one patient received unmanipulated G-CSF primed peripheral blood hematopoietic stem cells. Six patients received MRD allo-HCT, 1 MUD, and 20 haplo. All patients achieved primary engraftment. Acute GvHD grade ≥ II developed in 4/27 patients reaching a cumulative incidence (CI) of 15%. Two patients developed chronic GvHD. TRM occurred in 3/27 patients (CI: 11%). Causes of death were aGvHD in 1, and infective pneumonia in 2. Eight patients relapsed (CI: 30%) so far. Seven of them had active disease at transplant. The 2-year PFS is 63% and the probability of GvHD-free/relapse-free survival (GRFS) is 52% at a median follow up of 32 months (range 1.5m-5y) with 17/27 patients alive and lymphoma-free to date.
Conclusion
Here, we show that RIC allo-HCT with PT-Cy is a safe procedure with low rates of GvHD and TRM in a small series of patients. Despite the majority of patients had active disease at transplant, relapse rate appears not to be superior to the one reported after allo-HCT with myeloablative conditioning and/or with conventional IS regimens (e.g. Sureda et al. 2008). In conclusion, TBI-based RIC allo-HCT with PT-Cy ensured good PFS and GRFS in R/R lymphoma patients.
Keyword(s): Graft-versus-host disease (GVHD), Lymphoma, Reduced intensity transplantation, Transplant-related mortality
Abstract: EP1288
Type: E-Poster Presentation
Session title: Stem cell transplantation - Clinical
Background
Allogeneic hematopoietic cell transplantation (Allo-HCT) is a potentially curative treatment for patients with relapsed/refractory (R/R) lymphomas. Patients with R/R lymphomas usually reach allo-HCT after several lines of treatment and are often affected by comorbidities. Therefore, these patients are often unsuitable for high intensity myeloablative conditioning regimen. Historically, reduced intensity conditioning (RIC) regimens are feasible in this subset of patients, but they are complicated by high rate of graft versus host disease (GvHD) and disease relapse. The more recent introduction of post-transplant cyclophosphamide (PT-Cy) for GvHD prophylaxis reduced acute and chronic GvHD rates and transplant-related mortality (TRM) in comparison to allo-HCT with conventional immune suppressive (IS) regimens. In particular, haploidentical (haplo) allo-HCT with PT-Cy showed acceptable rate of TRM and good progression free survival (PFS) in Hodgkin lymphoma patients (Castagna et al 2017). We have recently introduced total body irradiation (TBI)-based RIC followed by PT-Cy for R/R lymphoma patients. We adopted such strategy across all the different donor/recipient HLA-matching combinations.
Aims
To evaluate safety and feasibility of TBI-based RIC allo-HCT followed by PT-Cy prophylaxis for R/R lymphoma patients at our center.
Methods
We adopted TBI-based RIC allo-HCT followed by PT-Cy for R/R lymphoma patients starting in April 2016. We collected data until December 2020. Conditioning regimen to transplant was based on fludarabine (150mg/m2 in 5 days) and cyclophosphamide (14.5 mg/kg for 2 days) followed by TBI (2-4 Gy). PT-Cy dose was 50mg/kg for 2 days at day 3 and 4 after allo-HCT. GvHD prophylaxis consisted also of Tacrolimus and Mycophenolate Mofetil in patients with matched unrelated donors (MUD) or haplo donors (haplo) and Cyclosporine alone in patients with matched related donors (MRD).
Results
Since April 2016 we transplanted 27 patients with R/R lymphoma using TBI-based reduced-intensity conditioning and PT-Cy based GvHD prophylaxis. Median age at transplant was 48 years (range 25-62). Median number of previous lines of therapy was 5. Thirteen patients were affected by Hodgkin Lymphoma and 14 by Non-Hodgkin Lymphoma (7 B lymphomas, 7 T lymphomas). Twelve patients were transplanted in hematological complete remission, while 15 had active disease at transplant. All but one patient received unmanipulated G-CSF primed peripheral blood hematopoietic stem cells. Six patients received MRD allo-HCT, 1 MUD, and 20 haplo. All patients achieved primary engraftment. Acute GvHD grade ≥ II developed in 4/27 patients reaching a cumulative incidence (CI) of 15%. Two patients developed chronic GvHD. TRM occurred in 3/27 patients (CI: 11%). Causes of death were aGvHD in 1, and infective pneumonia in 2. Eight patients relapsed (CI: 30%) so far. Seven of them had active disease at transplant. The 2-year PFS is 63% and the probability of GvHD-free/relapse-free survival (GRFS) is 52% at a median follow up of 32 months (range 1.5m-5y) with 17/27 patients alive and lymphoma-free to date.
Conclusion
Here, we show that RIC allo-HCT with PT-Cy is a safe procedure with low rates of GvHD and TRM in a small series of patients. Despite the majority of patients had active disease at transplant, relapse rate appears not to be superior to the one reported after allo-HCT with myeloablative conditioning and/or with conventional IS regimens (e.g. Sureda et al. 2008). In conclusion, TBI-based RIC allo-HCT with PT-Cy ensured good PFS and GRFS in R/R lymphoma patients.
Keyword(s): Graft-versus-host disease (GVHD), Lymphoma, Reduced intensity transplantation, Transplant-related mortality