1
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Kenkre VP, Bradley K, Milton A, Burkholder JK, Grindle K, McMannes J, Kim K, Callander N, Juckett M, Longo W, Hematti P. TCR-α/β and CD19 depleted stem cell grafts from haploidentical donors for allogeneic transplantation in patients with relapsed lymphoma: a single-center experience. Leuk Lymphoma 2023; 64:1875-1879. [PMID: 37585704 DOI: 10.1080/10428194.2023.2240918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/13/2023] [Accepted: 07/20/2023] [Indexed: 08/18/2023]
Affiliation(s)
- Vaishalee P Kenkre
- Division of Hematology, Oncology, Palliative Care, Department of Medicine, University of Wisconsin, Madison, WI, USA
| | - Kristin Bradley
- Department of Human Oncology, University of Wisconsin, Madison, WI, USA
| | - Arissa Milton
- Division of Hematology, Oncology, Palliative Care, Department of Medicine, University of Wisconsin, Madison, WI, USA
| | - Joseph K Burkholder
- Division of Hematology, Oncology, Palliative Care, Department of Medicine, University of Wisconsin, Madison, WI, USA
| | - Kreg Grindle
- Division of Hematology, Oncology, Palliative Care, Department of Medicine, University of Wisconsin, Madison, WI, USA
| | - Jan McMannes
- Division of Hematology, Oncology, Palliative Care, Department of Medicine, University of Wisconsin, Madison, WI, USA
| | - KyungMann Kim
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI, USA
| | - Natalie Callander
- Division of Hematology, Oncology, Palliative Care, Department of Medicine, University of Wisconsin, Madison, WI, USA
| | - Mark Juckett
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Walter Longo
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - Peiman Hematti
- Division of Hematology, Oncology, Palliative Care, Department of Medicine, University of Wisconsin, Madison, WI, USA
- Medical College of Wisconsin, Milwaukee, WI, USA
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2
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Munir F, Hardit V, Sheikh IN, AlQahtani S, He J, Cuglievan B, Hosing C, Tewari P, Khazal S. Classical Hodgkin Lymphoma: From Past to Future-A Comprehensive Review of Pathophysiology and Therapeutic Advances. Int J Mol Sci 2023; 24:10095. [PMID: 37373245 DOI: 10.3390/ijms241210095] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/04/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
Hodgkin lymphoma, a hematological malignancy of lymphoid origin that typically arises from germinal-center B cells, has an excellent overall prognosis. However, the treatment of patients who relapse or develop resistant disease still poses a substantial clinical and research challenge, even though current risk-adapted and response-based treatment techniques produce overall survival rates of over 95%. The appearance of late malignancies after the successful cure of primary or relapsed disease continues to be a major concern, mostly because of high survival rates. Particularly in pediatric HL patients, the chance of developing secondary leukemia is manifold compared to that in the general pediatric population, and the prognosis for patients with secondary leukemia is much worse than that for patients with other hematological malignancies. Therefore, it is crucial to develop clinically useful biomarkers to stratify patients according to their risk of late malignancies and determine which require intense treatment regimens to maintain the ideal balance between maximizing survival rates and avoiding late consequences. In this article, we review HL's epidemiology, risk factors, staging, molecular and genetic biomarkers, and treatments for children and adults, as well as treatment-related adverse events and the late development of secondary malignancies in patients with the disease.
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Affiliation(s)
- Faryal Munir
- Department of Pediatrics, Pediatric Hematology/Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Viney Hardit
- CARTOX Program, Department of Pediatrics, Pediatric Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Irtiza N Sheikh
- Department of Pediatrics, Pediatric Hematology/Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Shaikha AlQahtani
- Department of Pediatrics, Pediatric Hematology/Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jiasen He
- Department of Pediatrics, Pediatric Hematology/Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Branko Cuglievan
- Department of Pediatrics, Pediatric Hematology/Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Pediatrics-Patient Care, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Chitra Hosing
- Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Priti Tewari
- CARTOX Program, Department of Pediatrics, Pediatric Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Sajad Khazal
- CARTOX Program, Department of Pediatrics, Pediatric Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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3
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Faisal MS, Hanel W, Voorhees T, Li R, Huang Y, Khan A, Bond D, Sawalha Y, Reneau J, Alinari L, Baiocchi R, Christian B, Maddocks K, Efebera Y, Penza S, Saad A, Brammer J, DeLima M, Jaglowski S, Epperla N. Outcomes associated with allogeneic hematopoietic stem cell transplantation for relapsed and refractory Hodgkin lymphoma in the era of novel agents. Cancer Med 2023; 12:8228-8237. [PMID: 36653918 PMCID: PMC10134314 DOI: 10.1002/cam4.5631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/06/2023] [Accepted: 01/06/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Relapsed or refractory Hodgkin lymphoma (R/R HL) is a challenging disease with limited treatment options beyond brentuximab vedotin and checkpoint inhibitors. Herein we present the time-trend analysis of R/R HL patients who received allogeneic hematopoietic cell transplantation (allo-HCT) at our center from 2001-2017. METHODS The patients were divided into two distinct treatment cohorts: era1 (2001-2010), and era2 (2011-2017). The primary endpoint was overall survival (OS). Secondary endpoints included progression-free survival (PFS), non-relapse mortality (NRM), and cumulative incidence of acute and chronic graft versus host disease (GVHD). RESULTS Among the 51 patients included in the study, 29 were in era1, and 22 were in era2. There was decreased use of myeloablative conditioning in era2 (18% vs. 31%) compared to era1 and 95% of patients in era2 previously received brentuximab Vedotin (BV). Haploidentical donors were seen exclusively in era2 (0% vs. 14%) and more patients received alternative donor transplants (7% vs. 32%) in era2. The 4-year OS (34% vs. 83%, p < 0.001) and 4-year PFS (28% vs. 62%, p = 0.001) were significantly inferior in era1 compared to era2. The incidence of 1-year NRM was lower in era2 compared to era1 (5% vs. 34%, p = 0.06). The cumulative incidence of acute GVHD at day 100 was similar in both eras (p = 0.50), but the incidence of chronic GVHD at 1 year was higher in era2 compared to era1 (55% vs. 21%, p = 0.03). CONCLUSIONS Despite the advent of novel therapies, allo-HCT remains an important therapeutic option for patients with R/R HL.
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Affiliation(s)
- Muhammad Salman Faisal
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA.,Division of Hematology and Medical Oncology, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Walter Hanel
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Timothy Voorhees
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Rui Li
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Ying Huang
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Abdullah Khan
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - David Bond
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Yazeed Sawalha
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - John Reneau
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Lapo Alinari
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Robert Baiocchi
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Beth Christian
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Kami Maddocks
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Yvonne Efebera
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA.,Division of Hematology and Oncology, OhioHealth Bing Cancer Center, Columbus, Ohio, USA
| | - Sam Penza
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Ayman Saad
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Jonathan Brammer
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Marcos DeLima
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Samantha Jaglowski
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Narendranath Epperla
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
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4
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Allogeneic stem cell transplant in relapsed/ refractory Hodgkin lymphoma: A 21 years’ experience. Porto Biomed J 2022; 7:e173. [DOI: 10.1097/j.pbj.0000000000000173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 10/04/2021] [Indexed: 11/22/2022] Open
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5
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The outcome of patients with Hodgkin lymphoma and early relapse after autologous stem cell transplant has improved in recent years. Leukemia 2022; 36:1646-1653. [PMID: 35414657 DOI: 10.1038/s41375-022-01563-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 03/25/2022] [Accepted: 03/30/2022] [Indexed: 01/01/2023]
Abstract
Hodgkin lymphoma (HL) patients who relapse after autologous-stem-cell- transplantation (auto-SCT) have traditionally had a poor prognosis. We analyzed 1781 adult HL patients who relapsed between 2006 and 2017 after a first auto-SCT. The 4-year overall survival (OS) after relapse continuously increased from 32% for patients relapsing in 2006-2008, to 63% for patients relapsing in 2015-2017 (p = 0.001). The improvement over time was predominantly noted in patients who had an early relapse (within 12 months) after auto-SCT (p = 0.01). On multivariate analysis, patients who relapsed in more recent years and those with a longer interval from transplant to relapse had a better OS, whereas increasing age, poor performance status, bulky disease, extranodal disease and presence of B symptoms at relapse were associated with a worse OS. Brentuximab vedotin (BV), checkpoint inhibitors (CPI) and second transplant (SCT2; 86% allogeneic) were used in 233, 91 and 330 patients respectively. The 4-year OS from BV, CPI, and SCT2 use was 55%, 48% and 55% respectively. In conclusion, the outcome after post-transplant relapse has improved significantly in recent years, particularly in the case of early relapse. These large-scale real-world data can serve as benchmark for future studies in this setting.
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6
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Al-Juhaishi T, Borogovac A, Ibrahimi S, Wieduwilt M, Ahmed S. Reappraising the Role of Allogeneic Hematopoietic Stem Cell Transplantation in Relapsed and Refractory Hodgkin’s Lymphoma: Recent Advances and Outcomes. J Pers Med 2022; 12:jpm12020125. [PMID: 35207613 PMCID: PMC8880200 DOI: 10.3390/jpm12020125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/04/2022] [Accepted: 01/10/2022] [Indexed: 12/07/2022] Open
Abstract
Hodgkin’s lymphoma is a rare yet highly curable disease in the majority of patients treated with modern chemotherapy regimens. For patients who fail to respond to or relapse after initial systemic therapies, treatment with high-dose chemotherapy and autologous hematopoietic stem cell transplantation can provide a cure for many with chemotherapy-responsive lymphoma. Patients who relapse after autologous transplant or those with chemorefractory disease have poor prognosis and represent a high unmet need. Allogeneic hematopoietic stem cell transplantation provides a proven curative therapy for these patients and should be considered, especially in young and medically fit patients. The use of newer agents in this disease such as brentuximab vedotin and immune checkpoint inhibitors can help bring more patients to transplantation and should be considered as well.
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Affiliation(s)
- Taha Al-Juhaishi
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK 73104, USA; (A.B.); (S.I.); (M.W.)
- Correspondence: ; Tel.: +1-40527-18001
| | - Azra Borogovac
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK 73104, USA; (A.B.); (S.I.); (M.W.)
| | - Sami Ibrahimi
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK 73104, USA; (A.B.); (S.I.); (M.W.)
| | - Matthew Wieduwilt
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK 73104, USA; (A.B.); (S.I.); (M.W.)
| | - Sairah Ahmed
- MD Anderson Cancer Center, University of Texas, Houston, TX 77030, USA;
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7
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Stem-Cell Transplantation in Adult Patients with Relapsed/Refractory Hodgkin Lymphoma. TRANSPLANTOLOGY 2021. [DOI: 10.3390/transplantology2040038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Although the majority of patients with Hodgkin lymphoma (HL) are cured with initial therapy, in 85–90% of early stage and 70–80% of advanced-stage disease cases, relapse remains a major problem. Autologous stem-cell transplantation (auto-HCT) after salvage chemotherapy is currently considered to be the standard of care for patients who relapse after first-line chemotherapy or for whom first-line treatment fails. The curative capacity of auto-HCT has been improving with the introduction of new drug-based salvage strategies and consolidation strategies after auto-HCT. Allogeneic stem-cell transplantation (allo-HCT) represents a reasonable treatment option for young patients who relapse or progress after auto-HCT and have chemosensitive disease at the time of transplantation. Allo-HCT is a valid treatment strategy for patients with relapse/refractory HL (r/r HL) because the results have improved over time, mainly with the safe combination of allo-HCT and new drugs. Bearing in mind that outcomes after haploidentical stem-cell transplantation (haplo-HCT) are comparable with those for matched sibling donors and matched unrelated donors, haplo-HCT is now the preferred alternative donor source for patients with r/r HL without a donor or when there is urgency to find a donor if a matched related donor is not present. The development of new drugs such as anti-CD 30 monoclonal antibodies and checkpoint inhibitors (CPI) for relapsed or refractory HL has demonstrated high response rates and durable remissions, and challenged the role and timing of HCT. The treatment of patients with HL who develop disease recurrence or progression after allo-HCT remains a real challenge and an unmet need.
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8
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Shariati L, Esmaeili Y, Javanmard SH, Bidram E, Amini A. Organoid Technology: Current Standing and Future Perspectives. STEM CELLS (DAYTON, OHIO) 2021; 39:1625-1649. [PMID: 33786925 DOI: 10.1002/stem.3379] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/01/2021] [Indexed: 11/12/2022]
Abstract
Organoids are powerful systems to facilitate the study of individuals' disorders and personalized treatments. Likewise, emerging this technology has improved the chance of translatability of drugs for pre-clinical therapies and mimicking the complexity of organs, while it proposes numerous approaches for human disease modeling, tissue engineering, drug development, diagnosis, and regenerative medicine. In this review, we outline the past/present organoid technology and summarize its faithful applications, then, we discuss the challenges and limitations encountered by 3D organoids. In the end, we offer the human organoids as basic mechanistic infrastructure for "human modelling" systems to prescribe personalized medicines. © AlphaMed Press 2021 SIGNIFICANCE STATEMENT: This concise review concerns about organoids, available methods for in vitro organoid formation and different types of human organoid models. We, then, summarize biological approaches to improve 3D organoids complexity and therapeutic potentials of organoids. Despite the existing incomprehensive review articles in literature that examine partial aspects of the organoid technology, the present review article comprehensively and critically presents this technology from different aspects. It effectively provides a systematic overview on the past and current applications of organoids and discusses the future perspectives and suggestions to improve this technology and its applications.
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Affiliation(s)
- Laleh Shariati
- Applied Physiology Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Biomaterials, Nanotechnology and Tissue Engineering, School of Advanced Technologies in Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Yasaman Esmaeili
- Biosensor Research Center, School of Advanced Technologies in Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shaghayegh Haghjooy Javanmard
- Applied Physiology Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elham Bidram
- Department of Biomaterials, Nanotechnology and Tissue Engineering, School of Advanced Technologies in Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.,Biosensor Research Center, School of Advanced Technologies in Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abbas Amini
- Department of Mechanical Engineering, Australian College of Kuwait, Mishref, Safat, Kuwait.,Centre for Infrastructure Engineering, Western Sydney University, Penrith, NSW, Australia
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9
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Shah NN, Hamadani M. Is There Still a Role for Allogeneic Transplantation in the Management of Lymphoma? J Clin Oncol 2021; 39:487-498. [PMID: 33434076 DOI: 10.1200/jco.20.01447] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Nirav N Shah
- Blood and Bone Marrow Transplant and Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, WI
| | - Mehdi Hamadani
- Blood and Bone Marrow Transplant and Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, WI.,Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
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10
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Haploidentical Stem Cell Transplantation in Lymphomas-Expectations and Pitfalls. J Clin Med 2020; 9:jcm9113589. [PMID: 33171719 PMCID: PMC7695017 DOI: 10.3390/jcm9113589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/23/2020] [Accepted: 11/02/2020] [Indexed: 02/06/2023] Open
Abstract
T-cell replete Haploidentical stem cell transplantation (Haplo-SCT) with Post-transplant cyclophosphamide (PT-Cy) is an emerging therapeutic option for patients with advanced relapsed or refractory lymphoma. The feasibility of this platform is supported by several retrospective studies showing a toxicity profile that is improved relative to umbilical cord blood and mismatched unrelated donor (UD) transplant and comparable to matched unrelated donor transplant. In particular, cumulative incidence of chronic graft-versus-host disease (GVHD) is reduced after Haplo-SCT relative to UD and matched related donor (MRD) transplant thanks to PT-Cy employed as GVHD prophylaxis. This achievement, together with a similar incidence of acute GVHD and disease relapse, results in a promising advantage of Haplo-SCT in terms of relapse-free/GVHD free survival. Unmet needs of the Haplo-SCT platform are represented by the persistence of a not negligible rate of non-relapse mortality, especially due to infections and disease relapse. Future efforts are warranted in order to reduce life-threatening infections and to employ Halo-SCT with PT-Cy as a platform to build new immunotherapeutic strategies.
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11
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Castagna L, Santoro A, Carlo-Stella C. Salvage Therapy for Hodgkin's Lymphoma: A Review of Current Regimens and Outcomes. J Blood Med 2020; 11:389-403. [PMID: 33149713 PMCID: PMC7603406 DOI: 10.2147/jbm.s250581] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/06/2020] [Indexed: 12/20/2022] Open
Abstract
Relapse/refractory Hodgkin lymphoma patients are still a clinical concern. Indeed, despite more effective first-line chemotherapy regimens and better stratification of unresponsive patients by clinical factors and use of early PET, roughly one-third of such patients need salvage chemotherapy and consolidation with high-dose chemotherapy. In this paper, the authors review the different salvage treatments, with special emphasis on newer combinations with brentuximab vedotin or check point inhibitors. The overall response rate is constantly increasing, with a complete remission rate approaching 80%. Functional response evaluation by PET imaging is a strong predictive factor of longer survival, and more sophisticated tools, such as detection of circulating tumour DNA, are emerging to refine the disease-status assessment after treatment. Consolidation by high-dose chemotherapy is still considered the standard of care in chemosensitive patients, leading to a high fraction of patients towards long-term disease control. Maintenance therapy with BV is now approved, reducing disease relapse/progression. An increasing number of Hodgkin lymphoma patients will be cured after first- and second-line therapy, and long-term toxicity needs to be continuously assessed and avoided.
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Affiliation(s)
- Luca Castagna
- Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan 20089, Italy
| | - Armando Santoro
- Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan 20089, Italy.,Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan 20090, Italy
| | - Carmelo Carlo-Stella
- Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan 20089, Italy.,Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan 20090, Italy
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12
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Allo-HSCT in transplant-naïve patients with Hodgkin lymphoma: a single-arm, multicenter study. Blood Adv 2020; 3:4264-4270. [PMID: 31869413 DOI: 10.1182/bloodadvances.2019001016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 11/05/2019] [Indexed: 01/24/2023] Open
Abstract
We evaluated the role of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in transplant-naïve patients with relapsed/refractory Hodgkin lymphoma (HL) who failed to attain metabolic complete response (mCR) to 1 to 2 lines of salvage chemotherapyThose with residual but nonprogressive disease assessed by positron emission tomography/computed tomography scanning were eligible. An additional 1 to 2 cycles of salvage therapy were permissible in those with progressive disease or when required to bridge to allo-HSCT, with additional imaging at baseline before transplantation. Conditioning consisted of carmustine, etoposide, cytarabine, melphalan, and alemtuzumab. Donor lymphocyte infusions (DLI) were administered for mixed chimerism or residual or relapsed disease. Eleven patients had sibling donors, 13 had HLA-matched unrelated donors, and 7 had HLA-mismatched unrelated donors. There were no graft failures, and no episodes of grade 4 acute graft-versus-host disease (GVHD); only 19.4% of patients had grade 2 to 3 GVHD, and 22.2% had extensive chronic GVHD. The non-relapse mortality rate was 16.1% (95% confidence interval [CI], 7.1%-34.5%). Relapse incidence was 18.7% (95% CI, 8.2%-39.2%). The study met its primary objective, with a 3-year progression-free survival of 67.7% (95% CI, 48.4%-81.2%). Survival outcomes were equivalent in those with residual metabolically active disease immediately before transplantation (n = 24 [70.8%; 95% CI, 17.2%-83.7%]). Two of the 5 patients who relapsed received DLI and remained in mCR at latest follow-up, with a 3-year overall survival of 80.7% (95% CI, 61.9%-90.8%). We demonstrate encouraging results that establish a potential role for allo-HSCT in selected high-risk patients with HL. This trial was registered at www.clinicaltrials.gov as #NCT00908180.
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13
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Martínez C, Boumendil A, Romejko-Jarosinska J, Anagnostopoulos A, Faber E, Poiré X, Yakoub-Agha I, Akhtar S, Gurman G, Pavone V, Halaburda K, Sousa AB, Ghesquières H, Finel H, Khvedelidze I, Montoto S, Sureda A. Second autologous stem cell transplantation for relapsed/refractory Hodgkin lymphoma after a previous autograft: a study of the lymphoma working party of the EBMT. Leuk Lymphoma 2020; 61:2915-2922. [PMID: 32654552 DOI: 10.1080/10428194.2020.1789624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The purpose of this study was to analyze the results of second autologous hematopoietic stem cell transplantation (ASCT2) for patients with relapsed/refractory Hodgkin lymphoma (HL) after a first transplantation (ASCT1). Outcomes for 56 patients receiving an ASCT2 registered in the EBMT database were analyzed. The 4-year cumulative incidences of non-relapse mortality and disease relapse/progression were 5% and 67%, respectively. The 4-year overall survival (OS) and progression-free survival (PFS) were 62% and 28%. In univariate analysis, relapse of HL within 12 months of ASCT1 was associated with a worse OS (35% versus 76%, p = 0.01) and PFS (19% versus 29%, p = 0.059). Chemosensitivity at ASCT2 predicted better outcomes (4-year OS 72% versus 29%, p = 0.002; PFS 31% versus 12%, p = 0.015). This series shows that ASCT2 is a safe procedure and a relatively effective option for patients with late relapses after ASCT1 and with chemosensitive disease who are not eligible for an allogeneic transplant.
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Affiliation(s)
- Carmen Martínez
- Department of Hematology, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain
| | | | | | | | - Edgar Faber
- University Hospital, Olomouc, Czech Republic
| | - Xavier Poiré
- Cliniques Universitaires St. Luc, Brussels, Belgium
| | | | - Saad Akhtar
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Gunhan Gurman
- Faculty of Medicine, Ankara University, Ankara, Turkey
| | | | | | | | | | - Hervé Finel
- EBMT LWP Paris Office Hopital Saint-Antoine, Paris, France
| | | | - Silvia Montoto
- Department of Haemato-Oncology, St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Anna Sureda
- Department of Haematology, Institut Catala d'Oncologia, Hospital Duran I Reynals, Barcelona, Spain
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14
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Iqbal M, Kharfan-Dabaja MA. Relapse of Hodgkin lymphoma after autologous hematopoietic cell transplantation: A current management perspective. Hematol Oncol Stem Cell Ther 2020; 14:95-103. [PMID: 32603659 DOI: 10.1016/j.hemonc.2020.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 05/27/2020] [Indexed: 11/16/2022] Open
Abstract
Hodgkin lymphoma (HL) is a highly responsive disease with nearly 70% of patients experiencing cure after front-line chemotherapy. Patients who experience disease relapse receive salvage chemotherapy followed by consolidation with autologous hematopoietic cell transplantation (auto-HCT). Nearly 50% of patients relapse after an auto-HCT and constitute a subgroup with poor prognosis. Novel treatments such as immune checkpoint inhibitors and an anti-CD30 monoclonal antibody are currently approved for patients relapsing after auto-HCT; however, the duration of remission with these therapies remains limited. Allogeneic HCT is currently the only potentially curative treatment modality for patients relapsing after a prior auto-HCT. Early clinical trials with chimeric antigen receptor T-cell therapy targeting CD30 are underway for patients with relapsed/refractory HL and are already demonstrating safety and promising efficacy.
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Affiliation(s)
- Madiha Iqbal
- Division of Hematology-Oncology and Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology and Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA.
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15
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Sureda A, Genadieva Stavrik S, Boumendil A, Finel H, Khvedelidze I, Dietricht S, Dreger P, Hermine O, Kyriakou C, Robinson S, Schmitz N, Schouten HC, Tanase A, Montoto S. Changes in patients population and characteristics of hematopoietic stem cell transplantation for relapsed/refractory Hodgkin lymphoma: an analysis of the Lymphoma Working Party of the EBMT. Bone Marrow Transplant 2020; 55:2170-2179. [PMID: 32415225 DOI: 10.1038/s41409-020-0929-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 04/09/2020] [Accepted: 04/27/2020] [Indexed: 01/08/2023]
Abstract
Indications for autologous (auto-HCT) and allogeneic transplantation (allo-HCT) in relapsed/refractory Hodgkin lymphoma (rrHL) have been long established. The expectation is that long-term outcomes have significantly improved over time with increased experience in these procedures. The objective of this study was to assess whether this is the case and to identify further areas of improvement. A total of 13,639 adult patients receiving an auto-HCT or allo-HCT for rrHL were reported to the European Society for Blood and Marrow Transplantation (EBMT) over a 25-year period. Regarding auto-HCT, recipients are younger, interval between diagnosis and transplant shorter, peripheral blood has become the universal stem cell source and the use of total body irradiation is almost non-existent in recent years. Allo-HCT is currently mostly used as a second transplant; recipients are younger, fitter and less frequently, chemorefractory. Reduced intensity conditioning protocols have vastly replaced myeloablative protocols. Increasing numbers of haplo-HCT have been reported. Both in auto-HCT and allo-HCT, NRM, PFS and OS have significantly improved but relapse remains the main cause of treatment failure. A better selection of patients and improvements in the supportive care has resulted in a reduction in the NRM. Relapse after HCT remains unchanged and further research is needed.
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Affiliation(s)
- Anna Sureda
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, IDIBELL, University of Barcelona, Barcelona, Spain.
| | | | | | | | | | - Sascha Dietricht
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Peter Dreger
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Olivier Hermine
- Department of Clinical Haematology, AP-HP, Necker Hospital, Paris, France
| | - Chara Kyriakou
- Department of Hematology, University College London Hospital, London, UK
| | - Stephen Robinson
- Bone Marrow Transplant Unit, University Hospital Bristol, Bristol, UK
| | - Norbert Schmitz
- Department of Medicine A, Hematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Harry C Schouten
- Department of Hematology, Academische Ziekenhuis, Maastricht, Netherlands
| | - Alina Tanase
- Department of Stem Cell Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Silvia Montoto
- Department of Haemato-Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
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16
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Ahmed S, Ghosh N, Ahn KW, Khanal M, Litovich C, Mussetti A, Chhabra S, Cairo M, Mei M, William B, Nathan S, Bejanyan N, Olsson RF, Dahi PB, van der Poel M, Steinberg A, Kanakry J, Cerny J, Farooq U, Seo S, Kharfan-Dabaja MA, Sureda A, Fenske TS, Hamadani M. Impact of type of reduced-intensity conditioning regimen on the outcomes of allogeneic haematopoietic cell transplantation in classical Hodgkin lymphoma. Br J Haematol 2020; 190:573-582. [PMID: 32314807 DOI: 10.1111/bjh.16664] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/17/2020] [Accepted: 03/22/2020] [Indexed: 12/18/2022]
Abstract
Reduced-intensity conditioning (RIC) allogeneic haematopoietic cell transplantation (allo-HCT) is a curative option for select relapsed/refractory Hodgkin lymphoma (HL) patients; however, there are sparse data to support superiority of any particular conditioning regimen. We analyzed 492 adult patients undergoing human leucocyte antigen (HLA)-matched sibling or unrelated donor allo-HCT for HL between 2008 and 2016, utilizing RIC with either fludarabine/busulfan (Flu/Bu), fludarabine/melphalan (Flu/Mel140) or fludarabine/cyclophosphamide (Flu/Cy). Multivariable regression analysis was performed using a significance level of <0·01. There were no significant differences between regimens in risk for non-relapse mortality (NRM) (P = 0·54), relapse/progression (P = 0·02) or progression-free survival (PFS) (P = 0·14). Flu/Cy conditioning was associated with decreased risk of mortality in the first 11 months after allo-HCT (HR = 0·28; 95% CI = 0·10-0·73; P = 0·009), but beyond 11 months post allo-HCT it was associated with a significantly higher risk of mortality, (HR = 2·46; 95% CI = 0·1.32-4·61; P = 0·005). Four-year adjusted overall survival (OS) was similar across regimens at 62% for Flu/Bu, 59% for Flu/Mel140 and 55% for Flu/Cy (P = 0·64), respectively. These data confirm the choice of RIC for allo-HCT in HL does not influence risk of relapse, NRM or PFS. Although no OS benefit was seen between Flu/Bu and Flu/Mel 140; Flu/Cy was associated with a significantly higher risk of mortality beyond 11 months from allo-HCT (possibly due to late NRM events).
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Affiliation(s)
- Sairah Ahmed
- MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Nilanjan Ghosh
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Kwang W Ahn
- Department of Medicine, CIBMTR® (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Manoj Khanal
- Department of Medicine, CIBMTR® (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI, USA
| | - Carlos Litovich
- Department of Medicine, CIBMTR® (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI, USA
| | - Alberto Mussetti
- Hematology Department, Institut Catalá d'Oncologia - Hospitalet, Barcelona, Spain.,IDIBELL-Institut Català d'Oncologia, l'Hospitalet de Llobregat, El Prat de Llobregat, Spain
| | - Saurabh Chhabra
- Department of Medicine, CIBMTR® (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mitchell Cairo
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Department of Pediatrics, New York Medical College, Valhalla, NY, USA
| | | | - Basem William
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | | | - Nelli Bejanyan
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA
| | - Richard F Olsson
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Parastoo B Dahi
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Amir Steinberg
- Division of Hematology and Oncology, Mount Sinai Hospital, New York, NY, USA
| | | | - Jan Cerny
- Divsion of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Umar Farooq
- Division of Hematology, Oncology and Blood & Marrow Transplantation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Sachiko Seo
- Department of Hematology and Oncology, Dokkyo Medical University, Tochigi, Japan
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA
| | - Anna Sureda
- Hematology Department, Institut Català d'Oncologia - Hospitalet, IDIBELL, University of Barcelona, Barcelona, Spain
| | - Timothy S Fenske
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mehdi Hamadani
- Department of Medicine, CIBMTR® (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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17
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Nitrosourea, etoposide and cyclophosphamide followed by autologous stem cell transplantation for pediatric lymphoma patients. Int J Hematol 2020; 111:877-887. [PMID: 32215821 PMCID: PMC7222091 DOI: 10.1007/s12185-020-02863-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 03/10/2020] [Accepted: 03/11/2020] [Indexed: 12/22/2022]
Abstract
Treatment outcomes in pediatric lymphoma have improved substantially over the past 2 decades; however, the prognosis for patients with high risk or relapsed disease remains poor. We evaluated outcomes of high-dose chemotherapy (HDC) and autologous stem cell transplantation (auto-SCT) in 56 pediatric lymphoma patients. Patients received nitrosourea (51 BCNU; 5 ACNU), etoposide, and cyclophosphamide (BEC; AEC). Median age at HDC/auto-SCT was 12 years (range 2-17 years). Forty-four patients underwent HDC/auto-SCT because they did not achieve complete remission after induction chemotherapy. Eight patients showed relapse and four NK/T-cell lymphoma patients also underwent HDC/auto-SCT. BCNU pneumonitis was diagnosed in nine (16.0%) patients. Eight (14.3%) relapsed after HDC/auto-SCT. Treatment-related mortality occurred in three cases. Five-year event-free survival and overall survival rates were 74.8% [72.7% non-Hodgkin's lymphoma (NHL); 83.3% Hodgkin's disease (HD); 72.7%] and 83.6% (81.6% NHL; 91.7% HD), respectively. HDC/auto-SCT with BEC or AEC regimen for pediatric high-risk lymphoma patients showed feasible outcomes. However, treatment modifications are warranted to reduce relapse and toxicity.
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18
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Ikeda E, Ogawa M, Takeo M, Tsuji T. Functional ectodermal organ regeneration as the next generation of organ replacement therapy. Open Biol 2020; 9:190010. [PMID: 30836846 PMCID: PMC6451364 DOI: 10.1098/rsob.190010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
In this decade, substantial progress in the fields of developmental biology and stem cell biology has ushered in a new era for three-dimensional organ regenerative therapy. The emergence of novel three-dimensional cell manipulation technologies enables the effective mimicking of embryonic organ germ formation using the fate-determined organ-inductive potential of epithelial and mesenchymal stem cells. This advance shows great potential for the regeneration of functional organs with substitution of complete original function in situ. Organoids generated from multipotent stem cells or tissue stem cells via establishment of an organ-forming field can only partially recover original organ function owing to the size limitation; they are considered ‘mini-organs’. Nevertheless, they hold great promise to realize regenerative medicine. In particular, regeneration of a functional salivary gland and an integumentary organ system by orthotopic and heterotopic implantation of organoids clearly points to the future direction of organ regeneration research. In this review, we describe multiple strategies and recent progress in regenerating functional three-dimensional organs, focusing on ectodermal organs, and discuss their potential and future directions to achieve organ replacement therapy as a next-generation regenerative medicine.
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Affiliation(s)
- Etsuko Ikeda
- 1 Laboratory for Organ Regeneration, RIKEN Center for Biosystems Dynamics Research , Kobe, Hyogo 650-0047 , Japan
| | - Miho Ogawa
- 1 Laboratory for Organ Regeneration, RIKEN Center for Biosystems Dynamics Research , Kobe, Hyogo 650-0047 , Japan.,2 Organ Technologies Inc. , Tokyo 101-0048 , Japan
| | - Makoto Takeo
- 1 Laboratory for Organ Regeneration, RIKEN Center for Biosystems Dynamics Research , Kobe, Hyogo 650-0047 , Japan
| | - Takashi Tsuji
- 1 Laboratory for Organ Regeneration, RIKEN Center for Biosystems Dynamics Research , Kobe, Hyogo 650-0047 , Japan.,2 Organ Technologies Inc. , Tokyo 101-0048 , Japan
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19
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Vassilakopoulos TP, Asimakopoulos JV, Konstantopoulos K, Angelopoulou MK. Optimizing outcomes in relapsed/refractory Hodgkin lymphoma: a review of current and forthcoming therapeutic strategies. Ther Adv Hematol 2020; 11:2040620720902911. [PMID: 32110285 PMCID: PMC7026824 DOI: 10.1177/2040620720902911] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 12/18/2019] [Indexed: 12/21/2022] Open
Abstract
The outcome of patients with relapsed/refractory classical Hodgkin lymphoma (rr-cHL) has improved considerably in recent years owing to the approval of highly active novel agents such as brentuximab vedotin and Programmed Death-1 (PD-1) inhibitors. Although no randomized trials have been conducted to provide formal proof, it is almost undisputable that the survival of these patients has been prolonged. As autologous stem-cell transplantation (SCT) remains the standard of care for second-line therapy of most patients with rr-cHL, optimization of second-line regimens with the use of brentuximab vedotin, or, in the future, checkpoint inhibitors, is promising to increase both the eligibility rate for transplant and the final outcome. The need for subsequent therapy, and especially allogeneic SCT, can be reduced with brentuximab vedotin consolidation for 1 year, while pembrolizumab is also being tested in this setting. Several other drug categories appear to be active in rr-cHL, but their development has been delayed by the appearance of brentuximab vedotin, nivolumab and pembrolizumab, which have dominated the field of rr-cHL treatment in the last 5 years. Combinations of active drugs in chemo-free approaches may further increase efficacy and hopefully reduce toxicity in rr-cHL, but are still under development.
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Affiliation(s)
- Theodoros P. Vassilakopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., Goudi, Athens, 11527, Greece
| | - John V. Asimakopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Kostas Konstantopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Maria K. Angelopoulou
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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20
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Hutchings M, Ladetto M, Buske C, de Nully Brown P, Ferreri AJM, Pfreundschuh M, Schmitz N, Balari AS, van Imhoff G, Walewski J. ESMO Consensus Conference on malignant lymphoma: management of 'ultra-high-risk' patients. Ann Oncol 2019; 29:1687-1700. [PMID: 29924296 DOI: 10.1093/annonc/mdy167] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The European Society for Medical Oncology (ESMO) consensus conference on malignant lymphoma was held on 20 June 2015 in Lugano, Switzerland, and included a multidisciplinary panel of 25 leading experts. The aim of the conference was to develop recommendations on critical subjects difficult to consider in detail in the ESMO Clinical Practice Guidelines. The following areas were identified: (1) the elderly patient, (2) prognostic factors suitable for clinical use and (3) the 'ultra-high-risk' group. Before the conference, the expert panel was divided into three working groups; each group focused on one of these areas in order to address clinically relevant questions relating to that topic. All relevant scientific literature, as identified by the experts, was reviewed in advance. During the consensus conference, each working group developed recommendations to address each of the questions devised by their group. These recommendations were then presented to the entire multidisciplinary panel and a consensus was reached. This manuscript presents recommendations regarding the management of the following 'ultra-high-risk' situations: (1) early central nervous system relapse of diffuse large B-cell lymphoma, (2) primary refractory Hodgkin lymphoma and (3) plasmablastic lymphoma. Results, including a summary of evidence supporting each recommendation, are detailed in this manuscript. All expert panel members approved this final article.
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Affiliation(s)
- M Hutchings
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark.
| | - M Ladetto
- Hematology Division, Azienda Ospedaliera Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - C Buske
- Comprehensive Cancer Center Ulm and Department of Internal Medicine III, Institute of Experimental Cancer Research University Hospital, Ulm, Germany
| | | | - A J M Ferreri
- Department of Onco-Hematology Medicine, Unit of Lymphoid Malignancies, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - M Pfreundschuh
- Innere Medizin I, University Klinik des Saarlandes, Hamburg, Germany
| | - N Schmitz
- Department of Hematology, Oncology and Stem Cell Transplantation, Asklepios Klinik St. Georg, Hamburg, Germany
| | - A Sureda Balari
- Servei d'Hematologia, Institut Català d'Oncologia - Hospital Duran i Reynals, Barcelona, Spain
| | - G van Imhoff
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J Walewski
- Department of Lymphoid Malignancies, Maria Sklodowska-Curie Institute - Oncology Center, Warsaw, Poland
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21
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Rivas MM, Berro M, Prates MV, Yantorno S, Fiad L, Arbelbide JA, Basquiera AL, Ferini GA, García JJ, García PA, Riera L, Jarchum G, Baso A, Real J, Castro M, Jaimovich G, Martinez Rolón J, Foncuberta C, Saba S, Kusminsky G. Allogeneic stem cell transplantation improves survival in relapsed Hodgkin lymphoma patients achieving complete remission after salvage treatment. Bone Marrow Transplant 2019; 55:117-125. [PMID: 31435033 DOI: 10.1038/s41409-019-0640-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 07/26/2019] [Accepted: 07/31/2019] [Indexed: 01/12/2023]
Abstract
Allogeneic stem cell transplant (alloSCT) is a current treatment option for patients with refractory/relapsed classic Hodgkin lymphoma (CHL), including those who have failed an autologous transplantation. We performed a retrospective multicenter analysis of 113 patients (median age 28 years; range 14-56; 54% males) with refractory/relapsed (R/R) CHL who had undergone alloSCT in Argentina. Kaplan-Meier was used to estimate overall (OS) and progression-free survival (PFS). Relapse rate (RR) and non-relapse mortality (NRM) were estimated with cumulative incidence analysis. Disease status at transplant was complete remission (CR) in 39%, partial remission (PR) in 44%, and stable/progressed disease (S/PD) in 17% of the patients. Donor type was matched related (MRD) in 60%, unrelated (URD) in 19%, and haploidentical (HID) in 21% of the patients. OS and PFS at 2 years were 43% and 27%, respectively, for all the cohort. In the univariate analysis, patients in CR showed better OS (p ≤ 0.001) and PFS (p ≤ 0.001), and lower NRM (p = 0.04). HID had better PFS (p = 0.04) and lower RR (p = 0.02). In the multivariate analysis, CR showed a significant impact on OS and PFS, and HID on PFS. AlloSCT is a feasible procedure in patients with CHL. Those in CR at the time of the transplant had better outcomes. Haploidentical transplantation is associated with better PFS in these patients with poor prognosis.
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Affiliation(s)
| | - Mariano Berro
- Hospital Universitario Austral, Buenos Aires, Argentina
| | | | | | - Lorena Fiad
- Hospital Italiano de La Plata, Buenos Aires, Argentina
| | | | | | | | | | | | | | | | - Alfredo Baso
- Hospital Alemán de Buenos Aires, Buenos Aires, Argentina
| | - Juan Real
- Sanatorio Anchorena, Buenos Aires, Argentina
| | - Martín Castro
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | | | - Silvia Saba
- Hospital Rossi de La Plata, La Plata, Argentina
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22
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Should all patients with Hodgkin lymphoma who relapse after autologous SCT be considered for allogeneic SCT? Blood Adv 2019; 2:817-820. [PMID: 29636327 DOI: 10.1182/bloodadvances.2017011122] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 12/15/2017] [Indexed: 12/25/2022] Open
Abstract
Abstract
This article has a companion Counterpoint by Moskowitz.
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23
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Patel DA. Haploidentical Stem Cell Transplantation With Post-Transplantation Cyclophosphamide for Aggressive Lymphomas: How Far Have We Come and Where Are We Going? World J Oncol 2019; 10:1-9. [PMID: 30834047 PMCID: PMC6396776 DOI: 10.14740/wjon1164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 12/14/2018] [Indexed: 01/14/2023] Open
Abstract
Haploidentical hematopoietic stem cell transplantation (haplo-HSCT) with post-transplant cyclophosphamide (PTCy) offers universal donor availability and can potentially cure relapsed or primary refractory Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL). However, a conditioning regimen intensity that balances the graft-versus-lymphoma (GvL) effect with regimen-related toxicities (RRTs) has not yet been optimized. Limited data exist on the management of relapse, which is common post-transplant. Few prospective or randomized control trials have been conducted on lymphoma patients undergoing haplo-HSCT. Therefore, the current review aims to summarize published retrospective data in the field to help guide clinical decision making for high-risk patients. Retrospective studies in the field are characterized by variability in patient population and sample sizes, eligibility criteria, number of prior treatments (e.g., chemotherapy, radiation therapy, and autologous transplant), graft source (bone marrow or peripheral blood), as well as choice and intensity of the conditioning regimen (non-myeloablative, reduced intensity, or myeloablative). Nonetheless, common themes that emerge from the literature include: 1) Enhanced donor availability and selection with haplo-HSCT with success in heterogeneous patient populations; 2) Outcomes that are comparable if not superior to matched related (MRD) or unrelated (MUD) donor transplants; 3) The benefit of PTCy for reducing incidence of relapse and chronic graft-versus-host disease (GvHD); 4) Presence of co-morbidities leading to poorer transplant-related outcomes; and 5) The need for novel approaches to address disease relapse, particularly for patients with active disease at the time of transplant. Excellent transplant-related outcomes with haplo-HSCT with PTCy have been seen for HL and NHL based on retrospective data. Further studies are needed to determine integration with advanced cellular therapy techniques, such as chimeric antigen receptor (CAR) T-cell, antibody drug conjugates, and checkpoint inhibitors. Graft manipulation may be another avenue for future research.
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Affiliation(s)
- Dilan A Patel
- Vanderbilt Ingram Cancer Center, Vanderbilt University School of Medicine, 2220 Pierce Avenue, Nashville, TN 37232, USA.
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24
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Gaudio F, Mazza P, Carella AM, Mele A, Palazzo G, Pisapia G, Carluccio P, Pastore D, Cascavilla N, Specchia G, Pavone V. Outcomes of Reduced Intensity Conditioning Allogeneic Hematopoietic Stem Cell Transplantation for Hodgkin Lymphomas: A Retrospective Multicenter Experience by the Rete Ematologica Pugliese (REP). CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:35-40. [DOI: 10.1016/j.clml.2018.08.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/28/2018] [Accepted: 08/21/2018] [Indexed: 11/17/2022]
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25
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Keudell G, Younes A. Novel therapeutic agents for relapsed classical Hodgkin lymphoma. Br J Haematol 2018; 184:105-112. [DOI: 10.1111/bjh.15695] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Gottfried Keudell
- Lymphoma Service Memorial Sloan‐Kettering Cancer Center New York NY USA
| | - Anas Younes
- Lymphoma Service Memorial Sloan‐Kettering Cancer Center New York NY USA
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26
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Brierley CK, Jones FM, Hanlon K, Peniket AJ, Hatton C, Collins GP, Schuh A, Medd P, Clark A, Ward J, Chaganti S, Malladi R, Parker A, Craddock C, Danby R, Rocha V. Impact of graft-versus-lymphoma effect on outcomes after reduced intensity conditioned-alemtuzumab allogeneic haematopoietic stem cell transplantation for patients with mature lymphoid malignancies. Br J Haematol 2018; 184:547-557. [PMID: 30467838 DOI: 10.1111/bjh.15685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 10/08/2018] [Indexed: 10/27/2022]
Abstract
Allogeneic haematopoietic stem cell transplant (allo-HSCT) offers potentially curative therapy for patients with relapsed/refractory lymphoid malignancies. Reduced-intensity conditioning (RIC) with Alemtuzumab reduces transplant-related mortality and graft-versus-host disease (GvHD), but may be associated with increased risk of relapse. With the aim of studying the effect of GVHD and donor lymphocyte infusions (DLI) on relapse, we performed a retrospective study of 288 patients (57% non-Hodgkin lymphoma, 24% Hodgkin lymphoma and 19% chronic lymphocytic leukaemia; 58% were relapsed/refractory) who underwent RIC-Alemtuzumab-HSCT between 2000 and 2012. Median follow-up time for survivors was 64 months. Five-year overall survival, relapse incidence, GvHD/relapse-free survival and non-relapse mortality were 47%, 33%, 37% and 28% respectively. Cumulative incidence of grade II-IV acute and extensive chronic GvHD was 22% and 21% at 100 days and 5 years respectively. On multivariate analysis, presence of GvHD (P = 0·03) and unrelated donor type (P = 0·03) were protective of relapse. 62/288 patients received DLI for either mixed donor chimerism (prophylactic DLI, n = 37) or clinical relapse (therapeutic DLI, n = 25). Prophylactic and therapeutic DLI successfully converted the patient to full or stable mixed donor chimerism in 78% and 56% of patients respectively. These data demonstrate good long-term outcomes and support the concept of the graft-vs-lymphoma effect as a key protective factor against relapse following RIC-Alemtuzumab allo-HSCT for patients with mature lymphoid malignancies.
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Affiliation(s)
- Charlotte K Brierley
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Francesca M Jones
- Centre for Clinical Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Katharine Hanlon
- Department of Haematology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Andy J Peniket
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Chris Hatton
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Graham P Collins
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Anna Schuh
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Patrick Medd
- Department of Haematology, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - Andrew Clark
- Department of Haematology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Janice Ward
- Centre for Clinical Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sridar Chaganti
- Centre for Clinical Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ram Malladi
- Centre for Clinical Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Anne Parker
- Department of Haematology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Charles Craddock
- Centre for Clinical Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Robert Danby
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Vanderson Rocha
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Serviço de Hematologia, Hemoterapia e Terapia Celular, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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27
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Bazarbachi A, Boumendil A, Finel H, Mohty M, Castagna L, Blaise D, Peggs KS, Afanasyev B, Diez-Martin J, Corradini P, Michonneau D, Robinson S, Gutiérrez García G, Bonifazi F, Yakoub-Agha I, Gülbas Z, Bloor A, Delage J, Esquirol A, Malladi R, Scheid C, El-Cheikh J, Ghesquières H, Montoto S, Dreger P, Sureda A. Brentuximab vedotin for recurrent Hodgkin lymphoma after allogeneic hematopoietic stem cell transplantation: A report from the EBMT Lymphoma Working Party. Cancer 2018; 125:90-98. [DOI: 10.1002/cncr.31755] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/26/2018] [Accepted: 08/13/2018] [Indexed: 02/04/2023]
Affiliation(s)
- Ali Bazarbachi
- Department of Internal Medicine; American University of Beirut; Beirut Lebanon
| | - Ariane Boumendil
- European Society for Blood and Marrow Transplantation Lymphoma Working Party Paris Office; Saint-Antoine Hospital; Paris France
| | - Hervé Finel
- European Society for Blood and Marrow Transplantation Lymphoma Working Party Paris Office; Saint-Antoine Hospital; Paris France
| | - Mohamad Mohty
- Department of Hematology and Cell Therapy; Saint Antoine Hospital, Sorbonne University; Paris France
| | - Luca Castagna
- Department of Hematology and Oncology; Humanitas Clinic Institute; Rozzano Milan Italy
| | - Didier Blaise
- Department of Hematology; Paoli Calmettes Institute; Marseille France
| | - Karl S. Peggs
- Department of Hematology; University College London Hospital; London United Kingdom
| | - Boris Afanasyev
- Department of Hematology; First State Pavlov Medical University of St. Petersburg; St. Petersburg Russia
| | - J.L. Diez-Martin
- Department of Hematology; Gregorio Maranon Hospital; Madrid Spain
| | - Paolo Corradini
- Department of Hematology; IRCCS National Cancer Institute, University of Milan; Milan Italy
| | - David Michonneau
- Department of Hematology and Stem Cell Transplant; St. Louis Hospital; Paris France
| | - Stephen Robinson
- Department of Hematology and Oncology; University Hospital Bristol; Bristol United Kingdom
| | | | - Francesca Bonifazi
- Department of Hematology and Medical Oncology; Hematology Department “Seragnoli,” S. Orsola-Malpighi University Hospital; Bologna Italy
| | - Ibrahim Yakoub-Agha
- Department of Hematology, Lille Regional Hospital Center; LIRIC INSERM U995, Lille University; Lille France
| | - Zafer Gülbas
- Department of Hematologic Oncology and Bone Marrow Transplantation; Anadolu Medical Center Hospital; Kocaeli Turkey
| | - Adrian Bloor
- Department of Hematology and Stem Cell Transplant; Christie NHS Foundation Trust; Manchester United Kingdom
| | - Jeremy Delage
- Department of Clinical Hematology; Lapeyronie Regional Hospital Center; Montpellier France
| | - Albert Esquirol
- Department of Hematology; Santa Creu i Sant Pau Hospital; Barcelona Spain
| | - Ram Malladi
- Department of Hematology; Queen Elizabeth Hospital; Birmingham United Kingdom
| | - Christof Scheid
- Department of Internal Medicine; University of Cologne; Cologne Germany
| | - Jean El-Cheikh
- Department of Internal Medicine; American University of Beirut; Beirut Lebanon
| | | | - Silvia Montoto
- Department of Haemato-oncology, St Bartholomew’s Hospital; Barts Health NHS Trust; London United Kingdom
| | - Peter Dreger
- Department of Medicine V; University of Heidelberg; Heidelberg Germany
| | - Anna Sureda
- Department of Haematology; Catala Oncology Institute; Barcelona Spain
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28
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Paviglianiti A, Tozatto Maio K, Rocha V, Gehlkopf E, Milpied N, Esquirol A, Chevallier P, Blaise D, Gac AC, Leblond V, Cahn JY, Abecasis M, Zuckerman T, Schouten H, Gurman G, Rubio MT, Beguin Y, Corral LL, Nagler A, Snowden JA, Koc Y, Mordini N, Bonifazi F, Volt F, Kenzey C, Robinson SP, Montoto S, Gluckman E, Ruggeri A. Outcomes of Advanced Hodgkin Lymphoma after Umbilical Cord Blood Transplantation: A Eurocord and EBMT Lymphoma and Cellular Therapy & Immunobiology Working Party Study. Biol Blood Marrow Transplant 2018; 24:2265-2270. [PMID: 30031070 DOI: 10.1016/j.bbmt.2018.07.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 07/12/2018] [Indexed: 02/07/2023]
Abstract
Allogeneic stem cell transplantation is an alternative for patients with relapsed or refractory Hodgkin lymphoma (HL), but only limited data on unrelated umbilical cord blood transplantation (UCBT) are available. We analyzed 131 adults with HL who underwent UCBT in European Society for Blood and Marrow Transplantation centers from 2003 to 2015. Disease status at UCBT was complete remission (CR) in 59 patients (47%), and almost all patients had received a previous autologous stem cell transplantation. The 4-year progression-free survival (PFS) and overall survival (OS) were 26% (95% confidence interval [CI], 19% to 34%) and 46% (95% CI, 37% to 55%), respectively. Relapse incidence was 44% (95% CI, 36% to 54%), and nonrelapse mortality (NRM) was 31% (95% CI, 23% to 40%) at 4 years. In multivariate analysis refractory/relapsed disease status at UCBT was associated with increased relapse incidence (hazard ratio [HR], 3.14 [95% CI, 1.41 to 7.00], P = .005) and NRM (HR, 3.61 [95% CI, 1.58 to 8.27], P = .002) and lower PFS (HR, 3.45 [95% CI, 1.95 to 6.10], P < .001) and OS (HR, 3.10 [95% CI, 1.60 to 5.99], P = .001). Conditioning regimen with cyclophosphamide + fludarabine + 2 Gy total body irradiation (Cy+Flu+2GyTBI) was associated with decreased risk of NRM (HR, .26 [95% CI, .10 to .64], P = .004). Moreover, Cy+Flu+2GyTBI conditioning regimen was associated with a better OS (HR, .25 [95% CI, .12 to .50], P < .001) and PFS (HR, .51 [95% CI, .27 to .96], P = .04). UCBT is feasible in heavily pretreated patients with HL. The reduced-intensity conditioning regimen with Cy+Flu+2GyTBI is associated with a better OS and NRM. However, outcomes are poor in patients not in CR at UCBT.
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Affiliation(s)
- Annalisa Paviglianiti
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco
| | - Karina Tozatto Maio
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco
| | - Vanderson Rocha
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco; Department of Haematology, Hospital Sao Paulo, San Paulo, Brazil
| | - Eve Gehlkopf
- Service d'Hématologie, CHU Lapeyronie, Montpellier, France
| | - Noel Milpied
- Service d'Hématologie et Thérapie Cellulaire, Hôpital Haut-leveque, CHU Bordeaux, Pessac, France
| | - Albert Esquirol
- Clinical Hematology Service, Hospital de la Santa Creu i Sant Pau, Jose Carreras Leukaemia Research Institute, Barcelona, Spain
| | | | - Didier Blaise
- Service d'Hématologie et thérapie cellulaire, Institute Paoli Calmettes, Marseille, France
| | | | | | - Jean Yves Cahn
- Hématologie Clinique, CHU Grenoble Alpes, Grenoble, France
| | | | - Tsila Zuckerman
- Department of Hematology and BMT, Rambam Medical Center, Haifa, Israel
| | - Harry Schouten
- Department of Internal Medicine, Hematology and Oncology, University Hospital Maastricht, Maastricht, Netherlands
| | - Gunhan Gurman
- Department of Hematology Adult Stem Cell Transplantation Unit, Ankara University, Ankara, Turkey
| | - Marie Thérèse Rubio
- Service d'Hematologie et Therapie Cellulaire, Hôpitaux des Brabois, Nancy, France
| | - Yves Beguin
- Department of Hematology, CHU of Liège and University of Liege, Liege, Belgium
| | - Lucia Lopez Corral
- Hematology Department, Complejo Asistencial Universitario de Salamanca-IBSAL, Centro de Investigacion del Cancer-IBMCC, Salamanca, Spain
| | - Arnon Nagler
- Department of Hematology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - John A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
| | - Yener Koc
- Stem Cell Transplant Unit Medical Park Hospitals, Antalya, Turkey
| | - Nicola Mordini
- Division of Hematology, Az. Ospedaliera S. Croce e Carle, Cuneo, Italy
| | - Francesca Bonifazi
- Institute of Hematology, "Seragnoli" University Hospital S. Orsola-Malpighi, Bologna, Italy
| | - Fernanda Volt
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco
| | - Chantal Kenzey
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco
| | | | - Silvia Montoto
- Department of Haemato-Oncology, St. Bartholomew's Hospital, Barts Health NHS Trust, EBMT Lymphoma Working Party, London, United Kingdom
| | - Eliane Gluckman
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco
| | - Annalisa Ruggeri
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco; Hematology Department, Ospedale Pediatrico Bambin Gesù, Dipartimento di Oncoematologia e Terapia Cellulare e Genica, Rome, Italy.
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29
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Kallam A, Armitage JO. Current and emerging treatment options for a patient with a second relapse of Hodgkin’s lymphoma. Expert Rev Hematol 2018. [DOI: 10.1080/17474086.2018.1449637] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Avyakta Kallam
- Division of Oncology/Hematology, University of Nebraska Medical Center, Nebraska Medical Center, Omaha, NE, USA
| | - James O. Armitage
- Division of Oncology/Hematology, University of Nebraska Medical Center, Nebraska Medical Center, Omaha, NE, USA
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30
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Bazarbachi A, Boumendil A, Finel H, Mohty M, Castagna L, Peggs KS, Blaise D, Afanasyev B, Diez-Martin JL, Sierra J, Bloor A, Martinez C, Robinson S, Malladi R, El-Cheikh J, Corradini P, Montoto S, Dreger P, Sureda A. Brentuximab vedotin prior to allogeneic stem cell transplantation in Hodgkin lymphoma: a report from the EBMT Lymphoma Working Party. Br J Haematol 2018; 181:86-96. [PMID: 29468647 DOI: 10.1111/bjh.15152] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 12/28/2017] [Indexed: 01/11/2023]
Abstract
Brentuximab vedotin (BV) is an anti-CD30 antibody-drug conjugate. Preliminary data suggest that BV might improve outcomes after allogeneic stem cell transplantation (SCT) for Hodgkin lymphoma (HL) when used as pre-transplant salvage therapy. Between 2010 and 2014, 428 adult patients underwent an allogeneic SCT for classical HL at participating centres of the European Society for Blood and Marrow Transplantation. We compared the outcomes of 210 patients who received BV prior to allogeneic SCT with that of 218 patients who did not receive BV. The median follow-up for survivors was 41 months. Patients in the BV group were more heavily pre-treated (median pre-allograft treatment lines: 4 vs. 3). The two groups were comparable in terms of disease status, performance status, comorbidities, prior autologous SCT, type of donor, conditioning and in vivo T cell depletion. In multivariate analysis, pre-allograft BV had no impact on acute graft-versus-host disease (GVHD), non-relapse mortality, cumulative incidence of relapse, progression-free survival or overall survival (OS), but significantly reduced the risk of chronic GVHD (hazard ratio = 0·64; 95% confidence interval = 0·45-0·92; P < 0·02). Older age, poor performance status, use of pre-transplant radiotherapy and active disease at SCT adversely affected OS. Patients allografted for HL after prior exposure to BV do not have a superior outcome after allogeneic SCT except for a lower risk of chronic GVHD. However, BV may improve the outlook of allogeneic SCT by helping otherwise refractory patients to achieve a more favourable disease status, facilitating allotransplant success.
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Affiliation(s)
- Ali Bazarbachi
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | | | - Hervé Finel
- EBMT LWP Paris Office, Hôpital Saint-Antoine, Paris, France
| | - Mohamad Mohty
- Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, Paris, France
| | - Luca Castagna
- Department of Oncology and Haematology, Transplantation Unit, Istituto Clinico Humanitas, Milano, Italy
| | - Karl S Peggs
- Department of Haematology, University College London Cancer Institute, London, UK
| | - Didier Blaise
- Programme de Transplantation & Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | - Boris Afanasyev
- First State Pavlov Medical University of St. Petersburg, Raisa Gorbacheva Memorial Research Institute for Paediatric Oncology, Haematology, and Transplantation, St. Petersburg, Russia
| | - José L Diez-Martin
- Department of Haematology, Instituto de investigación sanitaria Gregorio Marañon, Facultad de Medicina, Universidad Complutense Madrid, Hospital GU Gregorio Marañon, Madrid
| | - Jorge Sierra
- Haematology Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Adrian Bloor
- Christie NHS Trust Hospital, Adult Leukaemia and Bone Marrow Transplant Unit, Manchester, UK
| | - Carmen Martinez
- Department of Haematology, Hospital Clinic, Institute of Haematology & Oncology, Barcelona, Spain
| | - Stephen Robinson
- Bone Marrow Transplant Unit, University Hospital Bristol, Bristol, UK
| | - Ram Malladi
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - Jean El-Cheikh
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Paolo Corradini
- Deptartment Haematology, IRCCS Istituto Nazionale dei Tumori, University of Milano, Milano, Italy
| | - Silvia Montoto
- Department of Haemato-Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Peter Dreger
- EBMT LWP Paris Office, Hôpital Saint-Antoine, Paris, France.,Deptartment Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Anna Sureda
- Department of Haematology, Institut Catala d'Oncologia, Hospital Duran I Reynals, Barcelona, Spain
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31
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Mauz-Körholz C, Ströter N, Baumann J, Botzen A, Körholz K, Körholz D. Pharmacotherapeutic Management of Pediatric Lymphoma. Paediatr Drugs 2018; 20:43-57. [PMID: 29127674 DOI: 10.1007/s40272-017-0265-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) comprise approximately 15% of all childhood malignancies. Cure rates for both lymphoma entities have evolved tremendously during the last couple of decades, raising the 5-year survival rates to almost 100% for HL and to 85% for NHL. The mainstay therapy for both malignancies is still chemotherapy-with different regimens recommended for different types of disease. In HL, combined modality treatment, i.e., chemotherapy followed by radiotherapy, has long been the standard regimen. In order to reduce long-term side effects, such as second malignancies, most major pediatric HL consortia have studied response-based radiotherapy reduction strategies over the last 3 decades. For recurrent disease, high-dose chemotherapy followed by an autologous or an allogeneic hematopoietic stem-cell transplant is an option. No targeted agents have yet gained regulatory approval for use in pediatric patients with lymphoma. For adult lymphoma patients, the CD20 antibody rituximab and the CD30 antibody-drug conjugate brentuximab vedotin are targeted agents used regularly in first- and second-line treatment regimens. More recently, immune checkpoint inhibitors, phosphatidyl-inositol-3-kinase inhibitors, and Bruton's tyrosine kinase inhibitors appear to be very promising new treatment options in adult lymphoma. Here, we discuss the current experience with these types of agents in pediatric lymphoma patients.
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Affiliation(s)
- Christine Mauz-Körholz
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Justus-Liebig University of Giessen, Feulgenstraße 12, 35392, Giessen, Germany. .,Medical Faculty of the Martin-Luther-University of Halle-Wittenberg, Halle, Germany.
| | - Natascha Ströter
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Justus-Liebig University of Giessen, Feulgenstraße 12, 35392, Giessen, Germany
| | - Julia Baumann
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Justus-Liebig University of Giessen, Feulgenstraße 12, 35392, Giessen, Germany
| | - Ante Botzen
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Justus-Liebig University of Giessen, Feulgenstraße 12, 35392, Giessen, Germany
| | - Katharina Körholz
- Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany.,Clinical Cooperation Unit Pediatric Oncology, German Cancer Research center (DKFZ), Heidelberg, Germany
| | - Dieter Körholz
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Justus-Liebig University of Giessen, Feulgenstraße 12, 35392, Giessen, Germany
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32
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Mei M, Chen R. How to Approach a Hodgkin Lymphoma Patient With Relapse After Autologous SCT: Allogeneic SCT. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 18:26-33. [PMID: 29233742 DOI: 10.1016/j.clml.2017.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 10/17/2017] [Accepted: 11/08/2017] [Indexed: 11/25/2022]
Abstract
Hodgkin lymphoma (HL) is a highly curable B-cell lymphoma, and ∼90% of patients who present with early-stage (stage I-II) disease and 70% of patients who present with late-stage disease will be cured with standard frontline treatment. For patients with relapsed or refractory (r/r) disease after initial therapy, the standard of care is salvage chemotherapy, followed by autologous transplantation (autoSCT). Although this approach will cure a significant proportion of patients, upto 50% of patients will experience disease progression after autoSCT, and this population has historically had a very poor prognosis. In the past, further salvage chemotherapy, followed by allogeneic transplantation (alloSCT), has been the only option associated with a significant probability of long-term survival, owing to a graft-versus-lymphoma effect. However, this approach has been complicated by high rates of treatment-related morbidity and mortality and a high risk of disease relapse. Furthermore, many patients have been unable to proceed to alloSCT because of disease refractoriness, poor performance status, or the lack of a donor. However, significant therapeutic advances in recent years have greatly expanded the options for patients with post-autoSCT r/r HL. These include the anti-CD30 antibody-drug conjugate brentuximab vedotin and the checkpoint inhibitors nivolumab and pembrolizumab, as well as increasing experience with alternative donor alloSCT, especially from haploidentical donors. In the present review, we discuss the current role of alloSCT in the treatment of HL after autoSCT relapse.
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Affiliation(s)
- Matthew Mei
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
| | - Robert Chen
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA.
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33
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Mariotti J, Devillier R, Bramanti S, Sarina B, Furst S, Granata A, Faucher C, Harbi S, Morabito L, Chabannon C, Carlo-Stella C, Bouabdallah R, Santoro A, Blaise D, Castagna L. T Cell-Replete Haploidentical Transplantation with Post-Transplantation Cyclophosphamide for Hodgkin Lymphoma Relapsed after Autologous Transplantation: Reduced Incidence of Relapse and of Chronic Graft-versus-Host Disease Compared with HLA-Identical Related Donors. Biol Blood Marrow Transplant 2017; 24:627-632. [PMID: 29197681 DOI: 10.1016/j.bbmt.2017.11.030] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 11/22/2017] [Indexed: 10/18/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (SCT) represents a potential curative strategy for patients with Hodgkin lymphoma (HL) relapsing after autologous SCT (ASCT), but the incidence of disease relapse is still high. We performed a retrospective study on 64 patients with HL relapsing after ASCT to compare outcomes after HLA-identical SCT (HLAid-SCT; n = 34) and haploidentical SCT with post-transplantation cyclophosphamide (PT-Cy) (Haplo-SCT; n = 30). All patients engrafted, with a significantly shorter median time for neutrophil and platelet engraftment after HLAid compared with Haplo-SCT (14 days versus 19 days and 11 days versus 23 days, respectively; P < .005). With a median follow-up of 47 months, 3-year overall survival (OS), 3 -year progression-free survival (PFS), and 1-year nonrelapse mortality (NRM) were 53%, 44% and 17%, respectively. Recipients of Haplo-SCT were less likely to experience disease relapse (3-year cumulative incidence of relapse, 13% versus 62%; P = .0001) and chronic graft- versus-host disease (GVHD; 3% versus 32%; P = .003), resulting in improved PFS (60% versus 29%; P = .04) and GVHD-free/relapse-free survival (47% versus 17%; P = .06). The 3-year OS did not differ between the 2 groups (56% versus 54%; P not significant), and NRM was higher after Haplo-SCT, but the difference did not reach statistical significance (26% versus 9%; P = .09). On multivariate Cox regression analysis, receipt of Haplo-SCT (hazard ratio [HR], .17; P = .02) and achieving optimal disease control (complete remission before SCT: HR, .6; P < .0001) were the only independent variables associated with a reduced risk of disease relapse. Haplo-SCT is a valid option for patients with HL relapsing after ASCT, with a reduced incidence of relapse compared with HLAid SCT.
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Affiliation(s)
- Jacopo Mariotti
- Bone Marrow Transplant Unit, Humanitas Clinical and Research Center, Rozzano, Italy.
| | - Raynier Devillier
- Department of Hematology, Transplantation Program, Institut Paoli-Calmettes, Marseille, France
| | - Stefania Bramanti
- Bone Marrow Transplant Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Barbara Sarina
- Bone Marrow Transplant Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Sabine Furst
- Department of Hematology, Transplantation Program, Institut Paoli-Calmettes, Marseille, France
| | - Angela Granata
- Department of Hematology, Transplantation Program, Institut Paoli-Calmettes, Marseille, France
| | - Catherine Faucher
- Department of Hematology, Transplantation Program, Institut Paoli-Calmettes, Marseille, France
| | - Samia Harbi
- Department of Hematology, Transplantation Program, Institut Paoli-Calmettes, Marseille, France
| | - Lucio Morabito
- Bone Marrow Transplant Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Christian Chabannon
- Cell Therapy Unit, Institut Paoli Calmettes, Marseille, France; Medicine Faculty, Aix-Marseille Université, Marseille, France; Centre de Recherche en Cancérologie de Marseille, Marseille, France
| | - Carmelo Carlo-Stella
- Bone Marrow Transplant Unit, Humanitas Clinical and Research Center, Rozzano, Italy; Department of Medical Biotechnology and Translational Medicine, University of Milano, Milano, Italy
| | - Reda Bouabdallah
- Department of Hematology, Transplantation Program, Institut Paoli-Calmettes, Marseille, France
| | - Armando Santoro
- Bone Marrow Transplant Unit, Humanitas Clinical and Research Center, Rozzano, Italy; Humanitas Clinical and Research Hospital, Humanitas University, Rozzano, Italy
| | - Didier Blaise
- Department of Hematology, Transplantation Program, Institut Paoli-Calmettes, Marseille, France; Medicine Faculty, Aix-Marseille Université, Marseille, France; Centre de Recherche en Cancérologie de Marseille, Marseille, France
| | - Luca Castagna
- Bone Marrow Transplant Unit, Humanitas Clinical and Research Center, Rozzano, Italy
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Martínez C, Gayoso J, Canals C, Finel H, Peggs K, Dominietto A, Castagna L, Afanasyev B, Robinson S, Blaise D, Corradini P, Itälä-Remes M, Bermúdez A, Forcade E, Russo D, Potter M, McQuaker G, Yakoub-Agha I, Scheid C, Bloor A, Montoto S, Dreger P, Sureda A. Post-Transplantation Cyclophosphamide-Based Haploidentical Transplantation as Alternative to Matched Sibling or Unrelated Donor Transplantation for Hodgkin Lymphoma: A Registry Study of the Lymphoma Working Party of the European Society for Blood and Marrow Transplantation. J Clin Oncol 2017; 35:3425-3432. [DOI: 10.1200/jco.2017.72.6869] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Purpose To compare the outcome of patients with Hodgkin lymphoma who received post-transplantation cyclophosphamide–based haploidentical (HAPLO) allogeneic hematopoietic cell transplantation with the outcome of patients who received conventional HLA-matched sibling donor (SIB) and HLA-matched unrelated donor (MUD). Patients and Methods We retrospectively evaluated 709 adult patients with Hodgkin lymphoma who were registered in the European Society for Blood and Marrow Transplantation database who received HAPLO (n = 98), SIB (n = 338), or MUD (n = 273) transplantation. Results Median follow-up of survivors was 29 months. No differences were observed between groups in the incidence of acute graft-versus-host disease (GVHD). HAPLO was associated with a lower risk of chronic GVHD (26%) compared with MUD (41%; P = .04). Cumulative incidence of nonrelapse mortality at 1 year was 17%, 13%, and 21% in HAPLO, SIB, and MUD, respectively, and corresponding 2-year cumulative incidence of relapse or progression was 39%, 49%, and 32%, respectively. On multivariable analysis, relative to SIB, nonrelapse mortality was similar in HAPLO ( P = .26) and higher in MUD ( P = .003), and risk of relapse was lower in both HAPLO ( P = .047) and MUD ( P < .001). Two-year overall survival and progression-free survival were 67% and 43% for HAPLO, 71% and 38% for SIB, and 62% and 45% for MUD, respectively. There were no significant differences in overall survival or progression-free survival between HAPLO and SIB or MUD. The rate of the composite end point of extensive chronic GVHD and relapse-free survival was significantly better for HAPLO (40%) compared with SIB (28%; P = .049) and similar to MUD (38%; P = .59). Conclusion Post-transplantation cyclophosphamide–based HAPLO transplantation results in similar survival outcomes compared with SIB and MUD, which confirms its suitability when no conventional donor is available. Our results also suggest that HAPLO results in a lower risk of chronic GVHD than MUD transplantation.
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Affiliation(s)
- Carmen Martínez
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
| | - Jorge Gayoso
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
| | - Carmen Canals
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
| | - Hervé Finel
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
| | - Karl Peggs
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
| | - Alida Dominietto
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
| | - Luca Castagna
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
| | - Boris Afanasyev
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
| | - Stephen Robinson
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
| | - Didier Blaise
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
| | - Paolo Corradini
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
| | - Maija Itälä-Remes
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
| | - Arancha Bermúdez
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
| | - Edouard Forcade
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
| | - Domenico Russo
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
| | - Michael Potter
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
| | - Grant McQuaker
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
| | - Ibrahim Yakoub-Agha
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
| | - Christof Scheid
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
| | - Adrian Bloor
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
| | - Silvia Montoto
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
| | - Peter Dreger
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
| | - Anna Sureda
- Carmen Martínez, Institute of Hematology and Oncology, Hospital Clínic; Carmen Canals, Banc de Sang i Teixits; Anna Sureda, Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; Jorge Gayoso, Hospital General Universitario Gregorio Marañón, Madrid; Arancha Bermúdez, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain; Carmen Martínez, Hervé Finel, Silvia Montoto, Peter Dreger, and Anna Sureda, European Society for Blood and Marrow Transplantation, Paris; Didier Blaise, Institut
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Khan N, Moskowitz AJ. Where Do the New Drugs Fit in for Relapsed/Refractory Hodgkin Lymphoma? Curr Hematol Malig Rep 2017; 12:227-233. [PMID: 28488185 DOI: 10.1007/s11899-017-0384-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The standard approach for relapsed or refractory (rel/ref) Hodgkin lymphoma (HL) following frontline treatment failure is salvage therapy followed by consolidation with high-dose therapy and autologous stem cell transplant (HDT/ASCT). While this overall treatment paradigm has been in place for several decades, recent studies have aimed to improve the efficacy and tolerability of salvage therapies by incorporating newer drugs, such as brentuximab vedotin (BV) and checkpoint inhibitors. Following HDT/ASCT, survival is improved due to the availability of BV and the checkpoint inhibitors, nivolumab and pembrolizumab; however, for patients responding to checkpoint inhibition, the appropriate length of treatment and the role of allogeneic stem cell transplant are unclear. In this review, we discuss our management of rel/ref HL, with particular focus on how BV, nivolumab, and pembrolizumab are currently incorporated into the treatment paradigms for rel/ref HL.
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Affiliation(s)
- Niloufer Khan
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Alison J Moskowitz
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
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Long-term follow-up of allogeneic stem cell transplantation in relapsed/refractory Hodgkin lymphoma. Bone Marrow Transplant 2017; 52:1208-1211. [PMID: 28581461 DOI: 10.1038/bmt.2017.99] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Karantanos T, Politikos I, Boussiotis VA. Advances in the pathophysiology and treatment of relapsed/refractory Hodgkin's lymphoma with an emphasis on targeted therapies and transplantation strategies. BLOOD AND LYMPHATIC CANCER-TARGETS AND THERAPY 2017; 7:37-52. [PMID: 28701859 PMCID: PMC5502320 DOI: 10.2147/blctt.s105458] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Hodgkin’s lymphoma (HL) is highly curable with first-line therapy. However, a minority of patients present with refractory disease or experience relapse after completion of frontline treatment. These patients are treated with salvage chemotherapy followed by autologous stem cell transplantation (ASCT), which remains the standard of care with curative potential for refractory or relapsed HL. Nevertheless, a significant percentage of such patients will progress after ASCT, and allogeneic hematopoietic stem cell transplantation remains the only curative approach in that setting. Recent advances in the pathophysiology of refractory or relapsed HL have provided the rationale for the development of novel targeted therapies with potent anti-HL activity and favorable toxicity profile, in contrast to cytotoxic chemotherapy. Brentuximab vedotin and programmed cell death-1-based immunotherapy have proven efficacy in the management of refractory or relapsed HL, whereas several other agents have shown promise in early clinical trials. Several of these agents are being incorporated with transplantation strategies in order to improve the outcomes of refractory or relapsed HL. In this review we summarize the current knowledge regarding the mechanisms responsible for the development of refractory/relapsed HL and the outcomes with current treatment strategies, with an emphasis on targeted therapies and hematopoietic stem cell transplantation.
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Affiliation(s)
- Theodoros Karantanos
- General Internal Medicine Section, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Ioannis Politikos
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Vassiliki A Boussiotis
- Division of Hematology-Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Beth Israel Deaconess Cancer Center, Harvard Medical School, Boston, MA, USA
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Jethava Y, Guru Murthy GS, Hamadani M. Relapse of Hodgkin lymphoma after autologous transplantation: Time to rethink treatment? Hematol Oncol Stem Cell Ther 2017; 10:47-56. [PMID: 28183681 DOI: 10.1016/j.hemonc.2016.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 12/07/2016] [Accepted: 12/29/2016] [Indexed: 11/29/2022] Open
Abstract
Relapse of Hodgkin lymphoma after autologous hematopoietic cell transplantation (autologous HCT) is a major therapeutic challenge. Its management, at least in younger patients, traditionally involves salvage chemotherapy aiming to achieve disease remission followed by consolidation with allogeneic hematopoietic cell transplantation (allogeneic HCT) in eligible patients. The efficacy of salvage therapy is variable and newer combination chemotherapy regimens have improved the outcomes. Factors such as shorter time to relapse after autologous HCT and poor performance status have been identified as predictors of poor outcome. Newer agents such as immunoconjugate brentuximab vedotin, checkpoint inhibitors (e.g., pembrolizumab, nivolumab), lenalidomide, and everolimus are available for the treatment of patients relapsing after autologous HCT. With the availability of reduced intensity conditioning allogeneic HCT, more patients are eligible for this therapy with lesser toxicity and better efficacy due to graft versus lymphoma effects. Alternative donor sources such as haploidentical stem cell transplantation and umbilical cord blood transplantation are expanding this procedure to patients without HLA-matched donors. However, strategies aimed at reduction of disease relapse after reduced intensity conditioning allogeneic HCT are needed to improve the outcomes of this treatment. This review summarizes the current data on salvage chemotherapy and HCT strategies used to treat patients with relapsed Hodgkin lymphoma after prior autologous HCT.
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Affiliation(s)
- Yogesh Jethava
- Division of Hematology-Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Mehdi Hamadani
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.
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Improving outcomes after allogeneic hematopoietic cell transplantation for Hodgkin lymphoma in the brentuximab vedotin era. Bone Marrow Transplant 2017; 52:697-703. [PMID: 28134921 PMCID: PMC5415418 DOI: 10.1038/bmt.2016.357] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/20/2016] [Accepted: 11/29/2016] [Indexed: 12/18/2022]
Abstract
Allogeneic hematopoietic cell transplantation (allo HCT) remains a valuable alternative for relapsed/refractory (R/R) Hodgkin lymphoma (HL). Data on allo HCT outcomes in the era of new HL therapies are needed. We evaluated 72 R/R HL patients who received reduced intensity conditioning (RIC) allo HCT and compared the time periods 2009-2013 (n=20) to 2000-2008 (n=52). Grafts included HLA-matched sibling (35%), unrelated donor (8%) and umbilical cord blood (UCB, 56%). In recent period, patients more often received brentuximab vedotin (BV, 60% vs 2%), had fewer comorbidities (Sorror index 0: 60% vs 12%) and were in complete remission (50% vs 23%). Median follow-up was 4.4 years. Three-year progression-free survival (PFS) improved for patients treated between 2009-2013 (49%, 95% CI 26-68%) as compared to the earlier era (23%, 95% CI 13-35%, p=0.02). Overall survival (OS) at 3-years was 84% (95% CI 57-94%) vs 50% (95% CI 36-62%, p=0.01), reflecting lower non-relapse mortality and relapse rates. In multivariate analysis mortality was higher among those with chemoresistance (HR 3.83, 95% CI 1.38-10.57), while treatment during the recent era was associated with better OS (HR for period 2009-2013: 0.24, 95% CI 0.07-0.79) and PFS (HR 0.46, 95% CI 0.23-0.92). Allo HCT in patients with R/R HL is now a more effective treatment.
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Haploidentical transplantation with post-infusion cyclophosphamide in advanced Hodgkin lymphoma. Bone Marrow Transplant 2017; 52:683-688. [DOI: 10.1038/bmt.2016.348] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 09/14/2016] [Accepted: 11/21/2016] [Indexed: 12/22/2022]
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Genadieva-Stavrik S, Boumendil A, Dreger P, Peggs K, Briones J, Corradini P, Bacigalupo A, Socié G, Bonifazi F, Finel H, Velardi A, Potter M, Bruno B, Castagna L, Malladi R, Russell N, Sureda A. Myeloablative versus reduced intensity allogeneic stem cell transplantation for relapsed/refractory Hodgkin's lymphoma in recent years: a retrospective analysis of the Lymphoma Working Party of the European Group for Blood and Marrow Transplantation. Ann Oncol 2016; 27:2251-2257. [DOI: 10.1093/annonc/mdw421] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 08/16/2016] [Accepted: 08/29/2016] [Indexed: 11/14/2022] Open
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Abstract
Despite the high first-line cure rates in patients with Hodgkin Lymphoma (HL) still 10%-20% of patients suffer from relapsed or refractory disease. High-dose chemotherapy (HDCT) followed by autologous stem cell transplant (ASCT) is standard of care for suitable patients with relapsed or refractory HL and allows for cure in approximately 50%. Due to the poor prognosis of high-risk patients even with HDCT and ASCT, consolidation strategies have been evaluated to improve the cure rates. For patients with recurrence after HDCT and ASCT, treatment is palliative in most cases. The anti-CD30 antibody-drug conjugate brentuximab vedotin (BV) has been shown to induce high response rates in these patients; however, durable responses were reported in a small percentage of patients only. For carefully selected patients with multiple relapses, dose-reduced allogeneic transplant (RICallo) is a potentially curative option. The role of RICallo will have to be re-evaluated in the era of anti-programmed death-1 (PD1) antibodies.
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Affiliation(s)
- Bastian von Tresckow
- German Hodgkin Study Group (GHSG), University Hospital of Cologne, Cologne, Germany
| | - Craig H Moskowitz
- Division of Hematologic Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Medicine, Weill Medical College of Cornell University, New York, NY.
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Busulfan-based reduced intensity conditioning regimens for haploidentical transplantation in relapsed/refractory Hodgkin lymphoma: Spanish multicenter experience. Bone Marrow Transplant 2016; 51:1307-1312. [DOI: 10.1038/bmt.2016.115] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 03/17/2016] [Accepted: 03/19/2016] [Indexed: 01/06/2023]
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Impact of Pretransplantation (18)F-Fluorodeoxyglucose-Positron Emission Tomography on Survival Outcomes after T Cell-Depleted Allogeneic Transplantation for Hodgkin Lymphoma. Biol Blood Marrow Transplant 2016; 22:1234-1241. [PMID: 27095691 DOI: 10.1016/j.bbmt.2016.03.034] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 03/30/2016] [Indexed: 11/23/2022]
Abstract
Pretransplant (18)F-fluorodeoxyglucose (FDG) positron emission tomography status is an important prognostic factor for outcomes after autologous stem cell transplantation (SCT) in Hodgkin lymphoma (HL), but its impact on outcomes after allogeneic SCT remains unclear. We retrospectively evaluated outcomes after T cell-depleted allogeneic SCT of 116 patients with nonprogressive HL according to pretransplant Deauville scores. Endpoints were overall survival (OS), progression-free survival (PFS), relapse rate (RR), and nonrelapse-related mortality (NRM). OS, PFS, and RR did not differ significantly between the Deauville 1 to 2 and Deauville 3 to 5 cohorts (OS: 77.5% versus 67.3%, P = .49; PFS: 59.4% versus 55.7%, P = .43; RR: 20.9% versus 22.6%, P = .28 at 4 years). Differences in PFS remained statistically nonsignificant when comparisons were made between Deauville 1 to 3 and Deauville 4 to 5 cohorts (60.9% versus 51.4%, P = .10), and RR remained very similar (21.5% versus 23.8%, P = .42). Multivariate analyses demonstrated trends toward significance for an effect of Deauville score on PFS (hazard ratio 1.82 for Deauville 4 to 5, P = .06) and for number of lines of prior therapy on OS (hazard ratio 2.34 for >5 lines, P = .10). The latter effect appeared to be driven by higher NRM rather than increased RR. Our findings suggest that Deauville score before allogeneic SCT in patients with nonprogressive HL has a relatively modest impact on survival outcomes in comparison with the impact in autologous SCT and that predictive values for the individual patient remain low, indicating that residual FDG-avid disease should not preclude allogeneic SCT. Furthermore, our findings bring into question the importance of attainment of metabolic complete response in this setting if it is at the expense of increasing NRM risk.
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45
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Rabitsch W, Bojic M, Wohlfarth P, Leiner M, Schörgenhofer C, Kalhs P, Schulenburg A, Sillaber C, Mitterbauer M, Sperr WR, Jäger U, Skrabs K, Greinix H, Hermann A, Lamm W. Alemtuzumab-BEAM as conditioning for allogeneic hematopoietic stem cell transplantation in relapsed/refractory Hodgkin lymphoma: a single-center analysis. J Cancer Res Clin Oncol 2016; 142:1307-14. [PMID: 26920356 PMCID: PMC4865538 DOI: 10.1007/s00432-016-2134-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 02/15/2016] [Indexed: 11/30/2022]
Abstract
Purpose
Treatment of refractory Hodgkin disease deserves specific considerations. Recently, alemtuzumab-BEAM has been introduced in allogeneic hematopoietic stem cell transplantation (HSCT) in these patients. Methods We retrospectively analyzed the outcome of 20 patients with relapsed/refractory Hodgkin’s lymphoma (HL) who received allogeneic HSCT following conditioning therapy with alemtuzumab-BEAM. Results Treatment-related toxicity was tolerable. Half of the patients (50 %) had infections. Of these, 50 % were found to have pneumonia or catheter-related infections. In 20 %, an oral mucositis was observed. Acute graft-versus-host disease (GvHD) (≥grade 2) was seen in three patients. Complete remission (CR) could be achieved in 17 patients (85 %), 2 patients had persistent Hodgkin disease, and 1 patient died from infection prior to CR evaluation. Median progression-free survival and overall survival were 17.9 and 67.5 months, respectively. From the 17 CR patients, 8 had a relapse after a median of 10 months. Notably, of the eight patients relapsing after HSCT, all patients received another salvage treatment and four patients are still alive, whereas the other four patients died due to further progress. Six out of the remaining nine patients are still in CR, whereas the other three died from chronic GvHD and multi-organ failure. Overall, seven patients experienced chronic GvHD. Conclusion In summary, alemtuzumab-BEAM is a well-tolerated conditioning therapy for allogeneic HSCT with high response rates in refractory HL.
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Affiliation(s)
- W Rabitsch
- Bone Marrow Transplant Unit, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - M Bojic
- Department of Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| | - P Wohlfarth
- Bone Marrow Transplant Unit, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - M Leiner
- Bone Marrow Transplant Unit, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - C Schörgenhofer
- Bone Marrow Transplant Unit, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - P Kalhs
- Bone Marrow Transplant Unit, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - A Schulenburg
- Bone Marrow Transplant Unit, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - C Sillaber
- Department of Medicine I, Clinical Division of Hematology, Medical University of Vienna, Vienna, Austria
| | - M Mitterbauer
- Bone Marrow Transplant Unit, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - W R Sperr
- Department of Medicine I, Clinical Division of Hematology, Medical University of Vienna, Vienna, Austria
| | - U Jäger
- Department of Medicine I, Clinical Division of Hematology, Medical University of Vienna, Vienna, Austria
| | - K Skrabs
- Department of Medicine I, Clinical Division of Hematology, Medical University of Vienna, Vienna, Austria
| | - H Greinix
- Division of Hematology, Medical University of Graz, Graz, Austria
| | - A Hermann
- Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, Vienna, Austria
| | - W Lamm
- Bone Marrow Transplant Unit, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
- Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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46
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Thompson PA, Perera T, Marin D, Oran B, Popat U, Qazilbash M, Shah N, Parmar S, Rezvani K, Olson A, Kebriaei P, Anderlini P, Rondon G, Alousi A, Ciurea S, Champlin RE, Bajel A, Szer J, Shpall EJ, Ritchie D, Hosing CM. Double umbilical cord blood transplant is effective therapy for relapsed or refractory Hodgkin lymphoma. Leuk Lymphoma 2015; 57:1607-15. [PMID: 26472485 DOI: 10.3109/10428194.2015.1105370] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A sub-group of patients with Hodgkin Lymphoma (HL) who relapse after autologous stem cell transplant can achieve long-term disease-free-survival after allogeneic stem cell transplant (alloSCT). There is limited information regarding the tolerability and efficacy of double umbilical cord blood transplant (dUCBT) for relapsed/refractory HL. We analyzed 27 consecutive, heavily pre-treated patients receiving dUCBT for relapsed/refractory HL at two centers from 2003-2014. The majority of patients relapsed <6 months after autologous stem cell transplant. A total of 15 patients received myeloablative (most commonly melphalan, fludarabine, thiotepa and anti-thymocyte globulin [ATG]) and 12 non-myeloablative conditioning regimens (fludarabine, cyclophosphamide, 200cGy total body irradiation +/- ATG). All patients engrafted; median time to neutrophil and platelet engraftment was 17 and 37 days, respectively. Overall response rate was 68%; 58% achieved complete remission. Median progression-free survival (PFS) was 12.2 months; median overall survival was 27 months. Cumulative incidences of relapse and of non-relapse mortality at 5 years were 30% and 37.9%, respectively; 5-year PFS was 31.3% (95%CI 10.1-52.5). There was a trend toward inferior PFS in patients with lymph node size ≥2 cm at the time of alloSCT (p = 0.07) and toward inferior survival in patients with chemorefractory disease pre-alloSCT (p = 0.12). dUCBT is feasible in patients with heavily pre-treated HL and can achieve long-term disease-free survival in approximately 30% of patients.
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Affiliation(s)
- Philip A Thompson
- a Department of Stem Cell Transplantation and Cellular Therapy , University of Texas M.D. Anderson Cancer Center , Houston , TX , USA
| | - Travis Perera
- b Department of Clinical Haematology and Bone Marrow Transplant Service , Royal Melbourne Hospital , Parkville , Australia
| | - David Marin
- a Department of Stem Cell Transplantation and Cellular Therapy , University of Texas M.D. Anderson Cancer Center , Houston , TX , USA
| | - Betul Oran
- a Department of Stem Cell Transplantation and Cellular Therapy , University of Texas M.D. Anderson Cancer Center , Houston , TX , USA
| | - Uday Popat
- a Department of Stem Cell Transplantation and Cellular Therapy , University of Texas M.D. Anderson Cancer Center , Houston , TX , USA
| | - Muzaffar Qazilbash
- a Department of Stem Cell Transplantation and Cellular Therapy , University of Texas M.D. Anderson Cancer Center , Houston , TX , USA
| | - Nina Shah
- a Department of Stem Cell Transplantation and Cellular Therapy , University of Texas M.D. Anderson Cancer Center , Houston , TX , USA
| | - Simrit Parmar
- a Department of Stem Cell Transplantation and Cellular Therapy , University of Texas M.D. Anderson Cancer Center , Houston , TX , USA
| | - Katayoun Rezvani
- a Department of Stem Cell Transplantation and Cellular Therapy , University of Texas M.D. Anderson Cancer Center , Houston , TX , USA
| | - Amanda Olson
- a Department of Stem Cell Transplantation and Cellular Therapy , University of Texas M.D. Anderson Cancer Center , Houston , TX , USA
| | - Partow Kebriaei
- a Department of Stem Cell Transplantation and Cellular Therapy , University of Texas M.D. Anderson Cancer Center , Houston , TX , USA
| | - Paolo Anderlini
- a Department of Stem Cell Transplantation and Cellular Therapy , University of Texas M.D. Anderson Cancer Center , Houston , TX , USA
| | - Gabriela Rondon
- a Department of Stem Cell Transplantation and Cellular Therapy , University of Texas M.D. Anderson Cancer Center , Houston , TX , USA
| | - Amin Alousi
- a Department of Stem Cell Transplantation and Cellular Therapy , University of Texas M.D. Anderson Cancer Center , Houston , TX , USA
| | - Stefan Ciurea
- a Department of Stem Cell Transplantation and Cellular Therapy , University of Texas M.D. Anderson Cancer Center , Houston , TX , USA
| | - Richard E Champlin
- a Department of Stem Cell Transplantation and Cellular Therapy , University of Texas M.D. Anderson Cancer Center , Houston , TX , USA
| | - Ashish Bajel
- b Department of Clinical Haematology and Bone Marrow Transplant Service , Royal Melbourne Hospital , Parkville , Australia
| | - Jeffrey Szer
- b Department of Clinical Haematology and Bone Marrow Transplant Service , Royal Melbourne Hospital , Parkville , Australia ;,c The Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne , Parkville , Australia
| | - Elizabeth J Shpall
- a Department of Stem Cell Transplantation and Cellular Therapy , University of Texas M.D. Anderson Cancer Center , Houston , TX , USA
| | - David Ritchie
- b Department of Clinical Haematology and Bone Marrow Transplant Service , Royal Melbourne Hospital , Parkville , Australia ;,c The Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne , Parkville , Australia
| | - Chitra M Hosing
- a Department of Stem Cell Transplantation and Cellular Therapy , University of Texas M.D. Anderson Cancer Center , Houston , TX , USA
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Martino M, Festuccia M, Fedele R, Console G, Cimminiello M, Gavarotti P, Bruno B. Salvage treatment for relapsed/refractory Hodgkin lymphoma: role of allografting, brentuximab vedotin and newer agents. Expert Opin Biol Ther 2015; 16:347-64. [PMID: 26652934 DOI: 10.1517/14712598.2015.1130821] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Second-line, salvage chemotherapy followed by high-dose chemotherapy and autologous stem cell transplantation (AUTO-SCT) is the standard of care for patients with relapsed/refractory (R/R) Hodgkin lymphoma (HL). Approximately 50% of patients relapse after AUTO-SCT and their prognosis is generally poor. Brentuximab Vedotin (BV) has demonstrated efficacy in this setting and allogeneic (ALLO)-SCT represents an option with curative potential in this subgroup of patients. AREAS COVERED A systematic review has been conducted to explore the actual knowledge on ALLO-SCT, BV and newer agents in R/R HL. EXPERT OPINION The introduction of BV in clinical practice has significantly improved the management of post-AUTO-SCT relapses and the drug can induce durable remissions in a subset of R/R HL. Allografting select patients has been used to improve clinical outcomes and recent case series have begun to explore BV as a potential 'bridge' to allo-SCT, even though the optimal timing of ALLO-SCT after BV response remains undetermined. However, reduced tumor burden at the time of ALLO-SCT is a key factor to decrease relapse risk. Based on the unique composition of the tumor, more recently new agents such as PD-1 inhibitors have been developed. The potential role of PD-1 inhibitors with ALLO-SCT remains to be explored.
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Affiliation(s)
- Massimo Martino
- a Hematology and Stem Cells Transplantation Unit , CTMO, Azienda Ospedaliera 'BMM' , Reggio , Italy
| | - Moreno Festuccia
- b Division of Hematology, A.O.U. Citta' della Salute e della Scienza di Torino - Presidio Molinette, and Department of Molecular Biotechnology and Health Sciences , University of Torino , Torino , Italy
| | - Roberta Fedele
- a Hematology and Stem Cells Transplantation Unit , CTMO, Azienda Ospedaliera 'BMM' , Reggio , Italy
| | - Giuseppe Console
- a Hematology and Stem Cells Transplantation Unit , CTMO, Azienda Ospedaliera 'BMM' , Reggio , Italy
| | - Michele Cimminiello
- c Hematology and Stem Cell Transplant Unit , Azienda Ospedaliera San Carlo , Potenza , Italy
| | - Paolo Gavarotti
- b Division of Hematology, A.O.U. Citta' della Salute e della Scienza di Torino - Presidio Molinette, and Department of Molecular Biotechnology and Health Sciences , University of Torino , Torino , Italy
| | - Benedetto Bruno
- b Division of Hematology, A.O.U. Citta' della Salute e della Scienza di Torino - Presidio Molinette, and Department of Molecular Biotechnology and Health Sciences , University of Torino , Torino , Italy
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48
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Paul DS, Jones A, Sellar RS, Mayor NP, Feber A, Webster AP, Afonso N, Sergeant R, Szydlo RM, Apperley JF, Widschwendter M, Mackinnon S, Marsh SGE, Madrigal JA, Rakyan VK, Peggs KS, Beck S. A donor-specific epigenetic classifier for acute graft-versus-host disease severity in hematopoietic stem cell transplantation. Genome Med 2015; 7:128. [PMID: 26669438 PMCID: PMC4681168 DOI: 10.1186/s13073-015-0246-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 11/12/2015] [Indexed: 02/07/2023] Open
Abstract
Background Allogeneic hematopoietic stem cell transplantation (HSCT) is a curative treatment for many hematological conditions. Acute graft-versus-host disease (aGVHD) is a prevalent immune-mediated complication following HSCT. Current diagnostic biomarkers that correlate with aGVHD severity, progression, and therapy response in graft recipients are insufficient. Here, we investigated whether epigenetic marks measured in peripheral blood of healthy graft donors stratify aGVHD severity in human leukocyte antigen (HLA)-matched sibling recipients prior to T cell-depleted HSCT. Methods We measured DNA methylation levels genome-wide at single-nucleotide resolution in peripheral blood of 85 HSCT donors, matched to recipients with various transplant outcomes, with Illumina Infinium HumanMethylation450 BeadChips. Results Using genome-wide DNA methylation profiling, we showed that epigenetic signatures underlying aGVHD severity in recipients correspond to immune pathways relevant to aGVHD etiology. We discovered 31 DNA methylation marks in donors that associated with aGVHD severity status in recipients, and demonstrated strong predictive performance of these markers in internal cross-validation experiments (AUC = 0.98, 95 % CI = 0.96–0.99). We replicated the top-ranked CpG classifier using an alternative, clinical DNA methylation assay (P = 0.039). In an independent cohort of 32 HSCT donors, we demonstrated the utility of the epigenetic classifier in the context of a T cell-replete conditioning regimen (P = 0.050). Conclusions Our findings suggest that epigenetic typing of HSCT donors in a clinical setting may be used in conjunction with HLA genotyping to inform both donor selection and transplantation strategy, with the ultimate aim of improving patient outcome. Electronic supplementary material The online version of this article (doi:10.1186/s13073-015-0246-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dirk S Paul
- UCL Cancer Institute, University College London, London, UK.
| | - Allison Jones
- Department of Women's Cancer, UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Rob S Sellar
- UCL Cancer Institute, University College London, London, UK.,Department of Haematology, University College London, University College London Hospital, London, UK
| | - Neema P Mayor
- UCL Cancer Institute, University College London, London, UK.,Anthony Nolan Research Institute, Royal Free Hospital, London, UK
| | - Andrew Feber
- UCL Cancer Institute, University College London, London, UK
| | - Amy P Webster
- UCL Cancer Institute, University College London, London, UK
| | - Neuza Afonso
- Department of Haematology, University College London, Royal Free Hospital, London, UK
| | - Ruhena Sergeant
- Clinical Immunology, Imperial NHS Trust Hammersmith Hospital, London, UK
| | - Richard M Szydlo
- Centre for Haematology, Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, UK.,Department of Clinical Haematology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Jane F Apperley
- Centre for Haematology, Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, UK.,Department of Clinical Haematology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Martin Widschwendter
- Department of Women's Cancer, UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Stephen Mackinnon
- UCL Cancer Institute, University College London, London, UK.,Department of Haematology, University College London, Royal Free Hospital, London, UK
| | - Steven G E Marsh
- UCL Cancer Institute, University College London, London, UK.,Anthony Nolan Research Institute, Royal Free Hospital, London, UK
| | - J Alejandro Madrigal
- UCL Cancer Institute, University College London, London, UK.,Anthony Nolan Research Institute, Royal Free Hospital, London, UK
| | - Vardhman K Rakyan
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
| | - Karl S Peggs
- UCL Cancer Institute, University College London, London, UK. .,Department of Haematology, University College London, University College London Hospital, London, UK.
| | - Stephan Beck
- UCL Cancer Institute, University College London, London, UK.
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49
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Nivolumab in a patient with refractory Hodgkin's lymphoma after allogeneic stem cell transplantation. Bone Marrow Transplant 2015; 51:443-5. [PMID: 26551782 DOI: 10.1038/bmt.2015.266] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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50
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Muto T, Ohwada C, Yamazaki A, Sugita Y, Tsukamoto S, Sakai S, Takeda Y, Mimura N, Takeuchi M, Sakaida E, Iseki T, Shimizu N, Morio T, Nakaseko C. Long-term complete remission by infusion of ex vivo-expanded donor-derived CD4(+) lymphocytes for treating an early relapse of Hodgkin lymphoma after cord blood transplantation. Leuk Lymphoma 2015; 57:230-2. [PMID: 25962436 DOI: 10.3109/10428194.2015.1041390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Tomoya Muto
- a Department of Hematology , Chiba University Hospital , Chiba , Japan
| | - Chikako Ohwada
- a Department of Hematology , Chiba University Hospital , Chiba , Japan
| | - Atsuko Yamazaki
- a Department of Hematology , Chiba University Hospital , Chiba , Japan
| | - Yasumasa Sugita
- a Department of Hematology , Chiba University Hospital , Chiba , Japan
| | | | - Shio Sakai
- a Department of Hematology , Chiba University Hospital , Chiba , Japan.,b Division of Transfusion Medicine and Cell Therapy, Chiba University Hospital , Chiba , Japan
| | - Yusuke Takeda
- a Department of Hematology , Chiba University Hospital , Chiba , Japan
| | - Naoya Mimura
- a Department of Hematology , Chiba University Hospital , Chiba , Japan.,b Division of Transfusion Medicine and Cell Therapy, Chiba University Hospital , Chiba , Japan
| | - Masahiro Takeuchi
- a Department of Hematology , Chiba University Hospital , Chiba , Japan
| | - Emiko Sakaida
- a Department of Hematology , Chiba University Hospital , Chiba , Japan
| | - Tohru Iseki
- a Department of Hematology , Chiba University Hospital , Chiba , Japan.,b Division of Transfusion Medicine and Cell Therapy, Chiba University Hospital , Chiba , Japan
| | - Norio Shimizu
- c Department of Virology , Medical Research Institute, Tokyo Medical and Dental University , Tokyo , Japan
| | - Tomohiro Morio
- d Department of Pediatrics and Developmental Biology , Tokyo Medical and Dental University , Tokyo , Japan
| | - Chiaki Nakaseko
- a Department of Hematology , Chiba University Hospital , Chiba , Japan
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