Modified conditioning regimen with idarubicin followed by autologous hematopoietic stem cell transplantation for invasive B-cell non-Hodgkin's lymphoma patients

Efficacy of Autologous Hematopoietic Stem Cell Transplantation versus Chemotherapy or Allogeneic Hematopoietic Stem Cell Transplantation for Follicular Lymphoma: Systematic Review and Meta-Analysis

BACKGROUND

The effect of autologous hematopoietic stem cell transplantation (auto-HSCT) versus conventional chemotherapy or allogeneic hematopoietic stem cell transplantation (allo-HSCT) on the survival of patients with advanced follicular lymphoma (FL) is uncertain.

OBJECTIVES

To elucidate this, FL and HSCT were used as keywords to search in PubMed, Embase, Web of Science, and Cochrane Library databases.

METHOD

After data extraction and quality evaluation, a total of 13 studies were included, seven of which compared auto-HSCT with conventional chemotherapy and the other six compared allo-HSCT with auto-HSCT to the survival of FL patients.

RESULTS

The results showed that auto-HSCT improved overall survival (OS), progression-free survival, and event-free survival of FL patients compared with conventional chemotherapy without auto-HSCT. Compared with allo-HSCT, the patients receiving auto-HSCT had longer OS and lower non-recurrent mortality.

CONCLUSIONS

Auto-HSCT can provide a survival advantage for patients with FL compared with conventional chemotherapy and allo-HSCT did not result in a survival benefit.

Comparison of CEAC, BEAM and IEAC conditioning regimens followed by autologous stem cell transplantation in peripheral T-cell lymphoma patients

Autologous stem cell transplantation (ASCT) is an important treatment for peripheral T-cell lymphoma (PTCL) patients both during front and salvage therapy. In order to explore the appropriate conditioning regiments and seek ways to improve the efficacy and safety of PTCL, we retrospectively compared the outcomes of 52 PTCL patients treated with CEAC (lomustine, etoposide, cytarabine and cyclophosphamide; n = 28), BEAM (carmustine, etoposide, cytarabine and melphalan; n = 14) and IEAC (idarubicin, etoposide, cytarabine and cyclophosphamide; n = 10) regimens followed by ASCT at our center between 2012 and 2021. Although the time of neutrophil engraftment in CEAC group was earlier than that in IEAC group (P = 0.042) and platelet infusion in BEAM group was significantly more than CEAC group (P = 0.042), there were no significant difference in platelet engraftment, hematopoietic engraftment and red blood cells infusion among the 3 groups. The transplantation related mortality rate (TRM) and the early overall response rate (ORR) was 3.8% and 85.7% respectively. The 5-year OS and PFS was 62.8% (95% CI: 54.8-70.8%) and 61.0% (95% CI: 53.1-68.9%) respectively. There was no significant difference in TRM, ORR and survival among the 3 groups. Univariate and multivariate analysis showed that high PIT score (the T cell lymphoma prognostic index, > 1) and failure to reach complete response (non-CR) at 3 months after ASCT were common risk factors for OS (P = 0.036 and 0.007) and PFS (P = 0.021 and 0.012). In conclusion, CEAC and IEAC regimen can be used as alternative conditioning regiments for ASCT in PTCL patients, and their efficacy and safety are comparable to BEAM regiment. Patients with high PIT score and non-CR early after ASCT had worse outcomes.

Safety and feasibility of stem cell boost as a salvage therapy for severe hematotoxicity after CD19 CAR T-cell therapy

CD19 CAR T-cells represent a practice-changing treatment modality for advanced B-cell malignancies. However, refractory cytopenias have emerged as a potentially life-threatening complication that can persist long after lymphodepleting chemotherapy. Whether stem cell rescue is feasible and efficacious after CAR-T has not been addressed. In this retrospective multi-center study, we describe clinical characteristics and outcomes of 13 patients with hyporegenerative bone marrow (BM) failure after CD19 CAR-T, which received a previously collected stem cell graft (10 autologous, 3 allogeneic) to rescue cytopenias. Interestingly, patients already presented with impaired hematopoietic function and high levels of systemic inflammation prior to lymphodepleting chemotherapy, as reflected by high CAR-HEMATOTOX scores (median 4). The median duration of severe neutropenia prior to stem cell boost was 41 days (interquartile range 16-50). The indication for boost was severe pancytopenia (aplasia) in 7 cases and persistent isolated neutropenia/thrombocytopenia in 6 cases. Median day of stem cell boost was day 55 after CAR-T (median 3.1x106/kg CD34+ cells). Engraftment rates were high (neutrophil: 92%, platelet: 70%), with a median time to neutrophil- and platelet engraftment of 15 and 21 days, respectively. Two patients died of invasive fungal infections (day 4 and 17 after stem cell boost). The 1-year progression-free (PFS) and overall survival (OS) rates were 42% and 51%, respectively. These data indicate that the transplantation of available stem cell products for post-CAR-T cytopenias is clinically feasible, safe and efficacious. Further studies are needed to assess, whether a pre-emptive collection of stem cells can be justified in selected high-risk patients.