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Montoro J, Boumendil A, Finel H, Bramanti S, Castagna L, Blaise D, Dominietto A, Kulagin A, Yakoub-Agha I, Tbakhi A, Solano C, Giebel S, Gulbas Z, López Corral L, Pérez-Simón JA, Díez Martín JL, Sanz J, Farina L, Koc Y, Socié G, Arat M, Jurado M, Bermudez A, Labussière-Wallet H, Villalba M, Ciceri F, Martinez C, Nagler A, Sureda A, Glass B. Post-Transplantation Cyclophosphamide-Based Graft-versus-Host Disease Prophylaxis in HLA-Matched and Haploidentical Donor Transplantation for Patients with Hodgkin Lymphoma: A Comparative Study of the Lymphoma Working Party of the European Society for Blood and Marrow Transplantation. Transplant Cell Ther 2024; 30:210.e1-210.e14. [PMID: 38043802 DOI: 10.1016/j.jtct.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/15/2023] [Accepted: 11/25/2023] [Indexed: 12/05/2023]
Abstract
Post-transplantation cyclophosphamide (PTCy) has emerged as a promising approach for preventing graft-versus-host disease (GVHD) in allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, there is a lack of studies examining the impact of this GVHD prophylaxis when different donor types are used in patients with Hodgkin lymphoma (HL). This study compared the outcomes of patients with HL undergoing HSCT from HLA-matched donors, including matched sibling donors (MSDs) and matched unrelated donors (MUDs), and haploidentical donors, using PTCy as the GVHD prophylaxis approach in all cohorts. We retrospectively compared outcomes of allo-HSCT from 166 HLA-matched donors (96 sibling and 70 unrelated donors) and 694 haploidentical donors using PTCy-based GVHD prophylaxis in patients with HL registered in the European Society for Blood and Marrow Transplantation database from 2010 to 2020. Compared to HLA-matched HSCT, haploidentical donor HSCT was associated with a significantly lower rate of platelet engraftment (86% versus 94%; P < .001) and a higher rate of grade II-IV acute GVHD (34% versus 24%; P = .01). The 2-year cumulative incidence of nonrelapse mortality (NRM) was significantly lower in the HLA-matched cohort compared to the haploidentical cohort (10% versus 18%; P = .02), resulting in a higher overall survival (OS) rate (82% versus 70%; P = .002). There were no significant differences between the 2 cohorts in terms of relapse, progression-free survival, or GVHD-free relapse-free survival. In multivariable analysis, haploidentical HSCT was associated with an increased risk of grade II-IV acute GVHD and NRM and worse OS compared to HLA-matched HSCT. Our findings suggest that in the context of PTCy-based GVHD prophylaxis, transplantation from HLA-matched donors appears to be a more favorable option compared to haploidentical HSCT.
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Affiliation(s)
- Juan Montoro
- Department of Hematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Universidad Católica de Valencia, Spain.
| | - Ariane Boumendil
- European Society for Blood and Marrow Transplantation Lymphoma Working Party, Paris, France
| | - Hervé Finel
- European Society for Blood and Marrow Transplantation Lymphoma Working Party, Paris, France
| | - Stefania Bramanti
- Department of Oncology/Hematology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Luca Castagna
- Department of Oncology/Hematology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Didier Blaise
- Programme de Transplantation and Therapie Cellulaire, Marseille, France
| | - Alida Dominietto
- UO Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Aleksandr Kulagin
- RM Gorbacheva Research Institute, Pavlov University, Saint Petersburg, Russia
| | | | | | - Carlos Solano
- Hematology Department, Hospital Clínico Universitario-INCLIVA, Valencia, Spain
| | - Sebastian Giebel
- The Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Zafer Gulbas
- Anadolu Health Center Avliated John Hopkins, Kocaeli, Gebze, Turkey
| | | | - José A Pérez-Simón
- Servicio de Hematología, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS), CSIC, Universidad de Sevilla, Spain
| | | | - Jaime Sanz
- Department of Hematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Lucia Farina
- University of Milan. Hematology Division, Fondazione IRCCS Istituto. Nazionale dei Tumori di Milano, Milan, Italy
| | - Yener Koc
- Medical Park Hospitals, Beylikduzu, Istanbul, Turkey
| | - Gerard Socié
- Department of Hematology - BMT, Hematology Transplantation, Paris, France
| | - Mutlu Arat
- Demiroglu Bilim University Istanbul Florence Nightingale Hospital, Hematopoietic SCT Unit, Istanbul, Turkey
| | | | | | | | - Marta Villalba
- Department of Hematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation Unit, Milano, Italy
| | - Carmen Martinez
- Hematopoietic Stem Cell Transplantation Unit, Hospital Clínic de Barcelona, Institute of Cancer and Blood Diseases, Barcelona, Spain
| | - Arnon Nagler
- Hematology Division, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Anna Sureda
- Hematology Department. Institut Català d'Oncologia, Hospital Duran i Reynals. Institut d'Investigació Biomèdica de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - Bertram Glass
- Department of Hematology, Oncology and Stem Cell Transplantation, Asklepios Klinik St. Georg, Hamburg, Germany
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Maranzano M, Mead M. The role of transplantation in Hodgkin lymphoma. Front Oncol 2023; 12:1054314. [PMID: 36776370 PMCID: PMC9908991 DOI: 10.3389/fonc.2022.1054314] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/06/2022] [Indexed: 01/27/2023] Open
Abstract
Despite the success of frontline anthracycline-based chemotherapy for classical Hodgkin Lymphoma (cHL), approximately 15% of patients do not achieve an adequate response and require further therapy. For transplant-eligible patients, additional treatment followed by high-dose chemotherapy and autologous hematopoietic stem cell transplantation (autoHCT) provides a durable response in 50% of patients. The most refractory patients, including those requiring multiple lines of therapy to achieve a response or those relapsing after an autoHCT, may achieve long-term survival with allogeneic hematopoietic stem cell transplant (alloHCT). Contemporary salvage regimens used as a bridge to transplant have expanded to include not only non-cross resistant chemotherapy, but also brentuximab vedotin (BV) and checkpoint inhibitors (CPI). As the management of relapsed/refractory (R/R) cHL evolves with the introduction of novel agents, so too does the role of transplantation. The paradigm of chemosensitivity as a predictor for autoHCT efficacy is being challenged by favorable post- autoHCT outcomes in heavily pre-treated CPI-exposed patients. Contemporary supportive care measures, validated comorbidity assessments, and an increased donor pool with haploidentical donors have broadened the application of transplantation to an increasingly older and diverse patient population. Despite the introduction of increasingly effective treatment options for R/R cHL, transplantation continues to play an important role in the management of these patients. In this review, we explore the impact of salvage therapy on autoHCT, conditioning regimens, maintenance therapy and the diminishing role of alloHCT for patients with cHL.
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Affiliation(s)
| | - Monica Mead
- Division of Hematology/Oncology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
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3
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Warley F, Berro M, Palmer S, Castro M, Ferini G, Lopez Orozco M, Otero V, Arbelbide J, Foncuberta C, Yantorno S, Basquiera A. Results with allo-SCT in patients with relapsed/refractory HL treated with anti-PD-1, a multicenter retrospective cohort study: subcommittee of transplantation and cellular therapy (GATMO-TC) of the Argentinian Hematology Society (SAH). Leuk Lymphoma 2022; 63:3508-3510. [PMID: 36111702 DOI: 10.1080/10428194.2022.2123238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
| | | | - Silvina Palmer
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | | | - Gonzalo Ferini
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Victoria Otero
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | | | - Ana Basquiera
- Hospital Privado Centro Medico de Cordoba, Cordoba, Argentina
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4
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Veilleux O, Claveau JS, Alaoui H, Roy J, Ahmad I, Delisle JS, Kiss T, Bambace NM, Bernard L, Cohen S, Sauvageau G, Fleury I, Mollica L, Roy DC, Seroukh Y, Lachance S. Real-world outcomes of autologous and allogeneic hematopoietic stem cell transplantation for relapsed/refractory Hodgkin lymphoma in the era of novel therapies: a Canadian perspective. Transplant Cell Ther 2021; 28:145-151. [PMID: 34954149 DOI: 10.1016/j.jtct.2021.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 12/01/2021] [Accepted: 12/05/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite high cure rates with frontline therapy for Hodgkin lymphoma (HL), about 30% of patients will relapse or have primary refractory disease (R/r). Autologous hematopoietic stem cell transplantation (AHSCT) is the standard of care for R/r disease and alloHSCT is a curative option for patients in second relapse. Novel agents are being incorporated for the treatment of R/r HL, such that the optimal timing of transplant is currently being challenged. Additionally, because access to these new agents varies amongst transplant centers, we sought to offer a Canadian perspective to the treatment of R/r HL and demonstrate the utility and effectiveness of both AHSCT and alloHSCT for the treatment of R/r HL. METHODS This single-center retrospective study examined outcomes in 89 consecutive patients with R/r HL treated with AHSCT between January 2007 and December 2019. A total of 17 patients underwent alloHSCT either as a tandem auto-allo approach or as salvage therapy. RESULTS With a median follow-up of 5.0 years, the estimated 5-year PFS and OS for patients undergoing AHSCT were 57.5% (95% CI 45.2-68.0) and 81.3% (95% CI 70.0-88.8), respectively. Corresponding figures for patients who underwent alloHSCT were 76.5% (95% CI 48.8-90.4) and 82.4% (95% CI 54.7-93.9). NRM at 100 days and 5 years was 0% and 9.4% post AHSCT and 0% and 5.9% post alloHSCT. Cumulative incidence (CI) of acute GVHD at day +100 was 35.3% (95% CI 17.7 - 62.3) and CI of chronic GVHD at 1 year was 23.5% (95% CI 6.9 - 45.8). CONCLUSIONS AHSCT and alloHSCT can both provide robust and prolonged disease control and new agents should be used as a bridge to improve the curative potential of these definitive cellular therapies.
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Affiliation(s)
- Olivier Veilleux
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Jean-Sébastien Claveau
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Habiba Alaoui
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Jean Roy
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Imran Ahmad
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Jean-Sébastien Delisle
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Thomas Kiss
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Nadia M Bambace
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Léa Bernard
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Sandra Cohen
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Guy Sauvageau
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Isabelle Fleury
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Luigina Mollica
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Denis-Claude Roy
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Yasmina Seroukh
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Sylvie Lachance
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada.
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5
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Holdsworth F, Worku D, Bretton AL, Vella C, Walker E. A guide to Hodgkin and non-Hodgkin lymphomas: similarities and differences. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2021; 30:S16-S22. [PMID: 34605260 DOI: 10.12968/bjon.2021.30.17.s16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
In the extraordinary times the COVID-19 pandemic has created for cancer patients and the health professionals caring for them, the need for strong knowledge and understanding of disease processes and treatments has never been more important. This article presents a review of Hodgkin lymphoma and non-Hodgkin lymphoma. These two common haematology diagnoses are frequently suspected by GPs and non-cancer professionals, and subsequently treated by haematologists and chemotherapy outpatient departments across the country. It is therefore important for all health professionals, including nurses in all settings, to be aware of the main characteristics of both of these lymphomas. There are strong similarities and striking differences between the disease processes, the presenting symptoms, prognostics and treatment pathways. The age of presentation in each is markedly different. There is a significant contrast in the number of subtypes between the two diagnoses, but the presenting symptoms are similar as are investigations required for diagnoses.
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Affiliation(s)
- Fiona Holdsworth
- Oncology Nurse Practitioner and Lecturer for Newcastle University
| | - Dominic Worku
- Postgraduate Master's Oncology and Palliative Care programme students, Newcastle University
| | - Alanna le Bretton
- Postgraduate Master's Oncology and Palliative Care programme students, Newcastle University
| | - Claire Vella
- Postgraduate Master's Oncology and Palliative Care programme students, Newcastle University
| | - Emma Walker
- Postgraduate Master's Oncology and Palliative Care programme students, Newcastle University
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6
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Kopińska A, Koclęga A, Wieczorkiewicz-Kabut A, Woźniczka K, Kata D, Włodarczyk M, Helbig G. Allogeneic Stem Cell Transplantation for Relapsed and Refractory Hodgkin Lymphoma: Real World Experience of a Single Center. Pathol Oncol Res 2021; 27:1609867. [PMID: 34385892 PMCID: PMC8354297 DOI: 10.3389/pore.2021.1609867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/15/2021] [Indexed: 11/13/2022]
Abstract
Introduction: Refractory and relapsed Hodgkin lymphoma (R/R HL) is associated with poor prognosis, and allogeneic stem cell transplantation (allo-SCT) remains the only potentially curative approach. Aim: The aim of the study was to evaluate the feasibility of allotransplantation in R/R HL setting. Material: Overall, 24 patients (17 men and 7 women) at a median age of 27 years (range 18–44) underwent allo-SCT between 2002 and 2020. Results: Nineteen patients received prior autologous stem cell transplantation (ASCT1) whereas eight patients received second ASCT (ASCT2) after failure of ASCT1. Six patients received only brentuximab vedotin (BV; n = 4) or BV followed by checkpoint inhibitors (CPI; n = 2) before entering allo-SCT. Median time from ASCT1 to allo-SCT was 17.1 months. Fifteen patients received grafts from unrelated donors. Peripheral blood was a source of stem cells for 16 patients. Reduced-intensity conditioning was used for all patients. Disease status at transplant entry was as follows: complete remission (CR; n = 4), partial response (PR; n = 10), and stable disease (SD; n = 10). Acute and chronic graft-versus-host disease (GVHD) developed in 13 (54%) and 4 (16%) patients, respectively. Median follow-up for the entire cohort was 13.3 months. At the last follow-up, 17 (71%) patients died. The main causes of death were disease progression (n = 10), infectious complications (n = 6), and steroid-resistant GVHD (n = 1). Non-relapse mortality at 12 months was 25%. At the last follow-up, seven patients were alive; six patients were in CR, and one had PR. The 2-year overall survival (OS) was 40%. Conclusion: Chemosensitive disease at transplant was associated with better outcome. Allo-SCT allows for long-term survival in refractory and relapsed HL.
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Affiliation(s)
- A Kopińska
- Department of Hematology and Bone Marrow Transplantation, Medical School of Silesia, Silesian Medical University, Katowice, Poland
| | - A Koclęga
- Department of Hematology and Bone Marrow Transplantation, Medical School of Silesia, Silesian Medical University, Katowice, Poland
| | - A Wieczorkiewicz-Kabut
- Department of Hematology and Bone Marrow Transplantation, Medical School of Silesia, Silesian Medical University, Katowice, Poland
| | - K Woźniczka
- Department of Hematology and Bone Marrow Transplantation, Medical School of Silesia, Silesian Medical University, Katowice, Poland
| | - D Kata
- Department of Hematology and Bone Marrow Transplantation, Medical School of Silesia, Silesian Medical University, Katowice, Poland
| | - M Włodarczyk
- Department of Hematology and Bone Marrow Transplantation, Medical School of Silesia, Silesian Medical University, Katowice, Poland
| | - G Helbig
- Department of Hematology and Bone Marrow Transplantation, Medical School of Silesia, Silesian Medical University, Katowice, Poland
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7
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Bobillo S, Nieto JC, Barba P. Use of checkpoint inhibitors in patients with lymphoid malignancies receiving allogeneic cell transplantation: a review. Bone Marrow Transplant 2021; 56:1784-1793. [PMID: 33742152 DOI: 10.1038/s41409-021-01268-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/18/2021] [Accepted: 03/03/2021] [Indexed: 01/01/2023]
Abstract
Monoclonal antibodies against checkpoint receptors or its ligands have demonstrated high response rates and durable remissions in patients with relapsed Hodgkin lymphoma (HL) and other lymphoid malignancies. However, most patients will eventually progress on therapy and may benefit from further treatments including allogenic hematopoietic cell transplantation (allo-HCT). Furthermore, the use of checkpoint inhibitors (CPI) has emerged as a treatment option for patients relapsing after allo-HCT. The immune effects of the checkpoint blockade leading to a T-cell activation have raised some concerns on the safety of these therapies used either before or after allo-HCT, due to the potential risk of graft-versus-host disease (GVHD). Furthermore, CPI might also induce other immune toxicities, that can affect almost any organ, as a result of the dysregulation on the immune system balance. This review aims to focus on the evidence behind the use of CPI in patients with lymphoma who undergo allo-HCT. We summarize the clinical data generated to date about the use of CPI in HL and other lymphoid malignancies, the mechanisms of checkpoint inhibition in the context of allo-HCT as well as the clinical and biological observations of different GVHD prophylaxis in this setting. Furthermore, we discuss the evidence from retrospective series and early clinical trials on the feasibility and safety of the use of CPI in patients who relapsed after allo-HCT.
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Affiliation(s)
- Sabela Bobillo
- Department of Hematology, University Hospital Vall d'Hebron and Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Camilo Nieto
- Laboratory of Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Pere Barba
- Department of Hematology, University Hospital Vall d'Hebron and Universitat Autònoma de Barcelona, Barcelona, Spain.
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8
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Carreau NA, Pail O, Armand P, Merryman R, Advani RH, Spinner MA, Herrera A, Chen R, Tomassetti S, Ramchandren R, Hamid MS, Assouline S, Santiago R, Wagner-Johnston N, Paul S, Svoboda J, Bair S, Barta S, Liu Y, Nathan S, Karmali R, Burkart M, Torka P, David K, Wei C, Lansigan F, Emery L, Persky D, Smith S, Godfrey J, Chavez J, Xia Y, Troxel AB, Diefenbach C. Checkpoint Blockade Treatment May Sensitize Hodgkin Lymphoma to Subsequent Therapy. Oncologist 2020; 25:878-885. [PMID: 32720734 DOI: 10.1634/theoncologist.2020-0167] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 07/16/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Targeted therapies and checkpoint blockade therapy (CBT) have shown efficacy for patients with Hodgkin lymphoma (HL) in the relapsed and refractory (R/R) setting, but once discontinued owing to progression or side effects, it is unclear how successful further therapies will be. Moreover, there are no data on optimal sequencing of these treatments with standard therapies and other novel agents. In a multicenter, retrospective analysis, we investigated whether exposure to CBT could sensitize HL to subsequent therapy. MATERIALS AND METHODS Seventeen centers across the U.S. and Canada retrospectively queried medical records for eligible patients. The primary aim was to evaluate the overall response rate (ORR) to post-CBT treatment using the Lugano criteria. Secondary aims included progression-free survival (PFS), duration of response, and overall survival (OS). RESULTS Eighty-one patients were included. Seventy-two percent had stage III-IV disease, and the population was heavily pretreated with a median of four therapies before CBT. Most patients (65%) discontinued CBT owing to progression. The ORR to post-CBT therapy was 62%, with a median PFS of 6.3 months and median OS of 21 months. Post-CBT treatment regimens consisted of chemotherapy (44%), targeted agents (19%), immunotherapy (15%), transplant conditioning (14%), chemotherapy/targeted combination (7%), and clinical trials (1%). No significant difference in OS was found when stratified by post-CBT regimen. CONCLUSION In a heavily pretreated R/R HL population, CBT may sensitize patients to subsequent treatment, even after progression on CBT. Post-CBT regimen category did not impact OS. This may be a novel treatment strategy, which warrants further investigation in prospective clinical trials. IMPLICATIONS FOR PRACTICE Novel, life-prolonging treatment strategies in relapsed and refractory (R/R) Hodgkin lymphoma (HL) are greatly desired. The results of this multicenter analysis concur with a smaller, earlier report that checkpoint blockade therapy (CBT) use in R/R HL may sensitize patients to their subsequent treatment. This approach may potentially enhance therapeutic options or to bridge patients to transplant. Prospective data are warranted prior to practice implementation. As more work is done in this area, we may also be able to optimize sequencing of CBT and novel agents in the treatment paradigm to minimize treatment-related toxicity and thus improve patient quality of life.
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Affiliation(s)
- Nicole A Carreau
- Division of Hematology and Medical Oncology, Perlmutter Cancer Center at NYU Langone Health, New York, New York, USA
| | - Orrin Pail
- Department of Medicine, New York University School of Medicine & Langone Medical Center, New York, New York, USA
| | - Philippe Armand
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Reid Merryman
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Ranjana H Advani
- Department of Medicine, Division of Oncology, Stanford University, Stanford, California, USA
| | - Michael A Spinner
- Department of Medicine, Division of Oncology, Stanford University, Stanford, California, USA
| | - Alex Herrera
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California, USA
| | - Robert Chen
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California, USA
| | - Sarah Tomassetti
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California, USA
| | - Radhakrishnan Ramchandren
- Division of Hematology and Oncology, University of Tennessee Medical Center, Knoxville, Tennessee, USA
| | - Muhammad S Hamid
- Department of Oncology, Karmanos Cancer Institute, Detroit, Michigan, USA
| | | | | | - Nina Wagner-Johnston
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Suman Paul
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jakub Svoboda
- Abramson Cancer Center, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Steven Bair
- Abramson Cancer Center, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stefan Barta
- Abramson Cancer Center, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yang Liu
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Sunita Nathan
- Rush University Medical Center, Chicago, Illinois, USA
| | - Reem Karmali
- Division of Hematology, Northwestern University, Chicago, Illinois, USA
| | - Madelyn Burkart
- Division of Hematology, Northwestern University, Chicago, Illinois, USA
| | - Pallawi Torka
- Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Kevin David
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Catherine Wei
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | | | - Lukas Emery
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Daniel Persky
- Division of Hematology/Oncology, University of Arizona Cancer Center, Tucson, Arizona, USA
| | | | | | | | - Yuhe Xia
- New York University School of Medicine, New York, New York, USA
| | - Andrea B Troxel
- New York University School of Medicine, New York, New York, USA
| | - Catherine Diefenbach
- Division of Hematology and Medical Oncology, Perlmutter Cancer Center at NYU Langone Health, New York, New York, USA
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Daw S, Hasenclever D, Mascarin M, Fernández-Teijeiro A, Balwierz W, Beishuizen A, Burnelli R, Cepelova M, Claviez A, Dieckmann K, Landman-Parker J, Kluge R, Körholz D, Mauz-Körholz C, Wallace WH, Leblanc T. Risk and Response Adapted Treatment Guidelines for Managing First Relapsed and Refractory Classical Hodgkin Lymphoma in Children and Young People. Recommendations from the EuroNet Pediatric Hodgkin Lymphoma Group. Hemasphere 2020; 4:e329. [PMID: 32072145 PMCID: PMC7000476 DOI: 10.1097/hs9.0000000000000329] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/14/2019] [Accepted: 11/22/2019] [Indexed: 01/21/2023] Open
Abstract
The objective of this guideline is to aid clinicians in making individual salvage treatment plans for pediatric and adolescent patients with first relapse or refractory (R/R) classical Hodgkin lymphoma (cHL). While salvage with standard dose chemotherapy followed by high dose chemotherapy and autologous stem cell transplant is often considered the standard of care in adult practice, pediatric practice adopts a more individualized risk stratified and response adapted approach to salvage treatment with greater use of non-transplant salvage. Here, we present on behalf of the EuroNet Pediatric Hodgkin Lymphoma group, evidence and consensus-based guidelines for standardized diagnostic, prognostic and response procedures to allocate children and adolescents with R/R cHL to stratified salvage treatments.
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Affiliation(s)
- Stephen Daw
- Children and Young People's Cancer Services, University College Hospital London, London, UK
| | - Dirk Hasenclever
- Institute of Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Maurizio Mascarin
- AYA and Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico, Aviano, Italy
| | - Ana Fernández-Teijeiro
- Unit of Pediatric Onco-Hematology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Walentyna Balwierz
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Auke Beishuizen
- Prinses Máxima Centrum voor Kinderoncologie, Utrecht, The Netherlands
| | - Roberta Burnelli
- Section of Pediatrics, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Michaela Cepelova
- Department of Pediatric Hematology and Oncology, University Hospital Motol, Czech Republic
| | - Alexander Claviez
- University Hospital Schleswig Holstein, Department of Pediatric and Adolescent Medicine, Pediatric Hematology, Oncology and Stem Cell Transplantation, Kiel, Germany
| | - Karin Dieckmann
- Department of Radiation Oncology, Medical University of Vienna, Vienna
| | | | - Regine Kluge
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Dieter Körholz
- Pädiatrische Hämatologie und Onkologie, Zentrum für Kinderheilkunde der Justus-Liebig-Universität Gießen, Gießen, Germany
| | - Christine Mauz-Körholz
- Pädiatrische Hämatologie und Onkologie, Zentrum für Kinderheilkunde der Justus-Liebig-Universität Gießen, Gießen, Germany
| | | | - Thierry Leblanc
- University of Edinburgh and Department of Pediatrics, Royal Hospital for Sick Children, Edinburgh, Scotland, UK
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Outcome after autologous stem cell transplantation in primary refractory or relapsed Hodgkin lymphoma-a long-term follow-up single center experience. Ann Hematol 2020; 99:265-276. [PMID: 31897675 DOI: 10.1007/s00277-019-03900-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 12/11/2019] [Indexed: 02/07/2023]
Abstract
Autologous stem cell transplantation (autoSCT) can achieve long-term remission in primary refractory or relapsed Hodgkin lymphoma (r/r HL); however, still up to 50% of patients relapse after autoSCT. In this retrospective analysis, we investigated the impact of autologous stem cell transplantation in a consecutive, unselected cohort of primary refractory and relapsed Hodgkin lymphoma patients (n = 66) with the majority of patients treated in the pre-brentuximab vedotin and immune checkpoint inhibitor era. In our cohort, a 5-year overall survival (OS) from autoSCT of 59.5% and a 5-year progression-free survival (PFS) after autoSCT of 46.1% was achieved. Multivariate analysis revealed primary refractory disease and early relapse (< 12 months) after initial therapy as well as the presence of B symptoms at relapse as independent risk factors associated with a higher risk for relapse and an inferior PFS and OS. Several other clinical factors, including the presence of extranodal disease at relapse and failure to achieve a complete response to salvage chemotherapy, were associated with a trend towards an inferior survival. Patients relapsing after autoSCT had a particularly poor outcome, regardless of eligibility to undergo allogeneic stem cell transplantation (alloSCT). We further evaluated recently published prognostic models for r/r HL patients undergoing autoSCT and could validate several risk scores in our independent "real world" cohort.
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11
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Mussetti A, Sureda A. Is this real life? Is this just fantasy? Decreased relapse following haploidentical transplant in Hodgkin’s lymphoma with posttransplant cyclophosphamide. Bone Marrow Transplant 2019; 55:483-484. [DOI: 10.1038/s41409-019-0754-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 11/01/2019] [Accepted: 11/06/2019] [Indexed: 11/09/2022]
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