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Berning P, Fekom M, Ngoya M, Goldstone AH, Dreger P, Montoto S, Finel H, Shumilov E, Chevallier P, Blaise D, Strüssmann T, Carpenter B, Forcade E, Castilla-Llorente C, Trneny M, Ghesquieres H, Capria S, Thieblemont C, Blau IW, Meijer E, Broers AEC, Huynh A, Caillot D, Rösler W, Nguyen Quoc S, Bittenbring J, Nagler A, Galimard JE, Glass B, Sureda A, Schmitz N. Hematopoietic stem cell transplantation for DLBCL: a report from the European Society for Blood and Marrow Transplantation on more than 40,000 patients over 32 years. Blood Cancer J 2024; 14:106. [PMID: 38969655 PMCID: PMC11226679 DOI: 10.1038/s41408-024-01085-9] [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: 04/04/2024] [Revised: 06/06/2024] [Accepted: 06/13/2024] [Indexed: 07/07/2024] Open
Abstract
Autologous(auto-) and allogeneic(allo-) hematopoietic stem cell transplantation (HSCT) are key treatments for relapsed/refractory diffuse large B-cell lymphoma (DLBCL), although their roles are challenged by CAR-T-cells and other immunotherapies. We examined the transplantation trends and outcomes for DLBCL patients undergoing auto-/allo-HSCT between 1990 and 2021 reported to EBMT. Over this period, 41,148 patients underwent auto-HSCT, peaking at 1911 cases in 2016, while allo-HSCT saw a maximum of 294 cases in 2018. The recent decline in transplants corresponds to increased CAR-T treatments (1117 cases in 2021). Median age for auto-HSCT rose from 42 (1990-1994) to 58 years (2015-2021), with peripheral blood becoming the primary stem cell source post-1994. Allo-HSCT median age increased from 36 (1990-1994) to 54 (2015-2021) years, with mobilized blood as the primary source post-1998 and reduced intensity conditioning post-2000. Unrelated and mismatched allo-HSCT accounted for 50% and 19% of allo-HSCT in 2015-2021. Three-year overall survival (OS) after auto-HSCT improved from 56% (1990-1994) to 70% (2015-2021), p < 0.001, with a decrease in relapse incidence (RI) from 49% to 38%, while non-relapse mortality (NRM) remained unchanged (4%). After allo-HSCT, 3-year-OS increased from 33% (1990-1999) to 46% (2015-2021) (p < 0.001); 3-year RI remained at 39% and 1-year-NRM decreased to 19% (p < 0.001). Our data reflect advancements over 32 years and >40,000 transplants, providing insights for evaluating emerging DLBCL therapies.
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Affiliation(s)
- Philipp Berning
- Department of Hematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Mathilde Fekom
- European Society for Blood and Marrow Transplantation, Paris, France
| | - Maud Ngoya
- European Society for Blood and Marrow Transplantation, Paris, France
| | | | - Peter Dreger
- Department of Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Silvia Montoto
- St. Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Hervé Finel
- European Society for Blood and Marrow Transplantation, Paris, France
| | - Evgenii Shumilov
- Department of Hematology and Oncology, University Hospital Muenster, Muenster, Germany
| | | | - Didier Blaise
- Transplantation and Cellular Immunotherapy Program, Department of Hematology, Instititut Paoli Calmettes, MSC Lab, Aix Marseille University, Marseille, France
| | - Tim Strüssmann
- Department of Hematology, Oncology and Stem Cell Transplantation, University of Freiburg Medical Center, Freiburg, Germany
| | - Ben Carpenter
- Department of Hematology, University College London Hospitals, London, United Kingdom
| | - Edouard Forcade
- Service d'Hématologie Clinique et Thérapie Cellulaire, CHU Bordeaux, F-33000, Bordeaux, France
| | | | - Marek Trneny
- First Faculty of Medicine, Charles University, Praha, Czech Republic
| | - Hervé Ghesquieres
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d'Hématologie, Pierre Bénite, France
| | - Saveria Capria
- Department of Translational and Precision Medicine, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Igor Wolfgang Blau
- Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität Berlin, Department of Hematology, Oncology and Tumor Immunology, Campus Virchow Clinic, Berlin, Germany
| | - Ellen Meijer
- Department of Hematology, Amsterdam University Medical Center, Free University, Amsterdam, the Netherlands
| | - Annoek E C Broers
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Anne Huynh
- CHU - Institut Universitaire du Cancer Toulouse, Oncopole, I.U.C.T-O, Toulouse, France
| | | | - Wolf Rösler
- Department of Internal Medicine 5, Hematology and Oncology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Stephanie Nguyen Quoc
- Department of Hematology, AP-HP, Sorbonne Université, Pitié- Salpêtrière Hospital, Paris, France
| | - Jörg Bittenbring
- Department of Hematology and Oncology, Saarland University Medical School, Homburg, Germany
| | - Arnon Nagler
- Division of Hematology, Sheba Medical Center, Tel Hashomer, Israel
| | | | - Bertram Glass
- Department of Hematology, Oncology, Tumor Immunology, and Palliative Care, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Anna Sureda
- Department of Hematology, Institut Català d'Oncologia Hospitalet, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - Norbert Schmitz
- Department of Hematology and Oncology, University Hospital Muenster, Muenster, Germany.
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Mercadal S, Mussetti A, Lee CJ, Arevalo C, Odstrcil SM, Peña E, Sureda A, Couriel DR. Allogeneic stem cell transplantation and CAR-T in B-cell Non-Hodgkin Lymphoma: a two-center experience and review of the literature. Ann Hematol 2024; 103:1717-1727. [PMID: 38429536 DOI: 10.1007/s00277-024-05677-0] [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: 08/17/2023] [Accepted: 02/16/2024] [Indexed: 03/03/2024]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is still a potentially curative option for B-cell Non-Hodgkin Lymphoma (B-NHL) in the modern immunotherapy era. The objective of this study was to analyze long-term outcomes of patients with B-NHL who received allo-HSCT. We analyzed overall survival (OS), progression-free survival (PFS) and graft versus host disease (GVHD) relapse-free survival (GRFS) in 53 patients undergoing allo-HSCT from two institutions. The median follow-up of the study was 72 months (range 29-115 months). The median number of lines of therapy before allo-HSCT was 3 (range 1-6) and twenty-eight patients (53%) had received a previous autologous transplant. The 3-year PFS, OS and GRFS were 55%, 63%, and 55%, respectively. One-year non-relapse mortality was 26%. Karnofsky Performance Scale < 90 was associated with worse OS in multivariable analysis. A non-comparative analysis of a cohort of 44 patients with similar characteristics who received chimeric antigen receptor T-cell therapy was done, showing a 1-year PFS and OS were 60% and 66%, respectively. Our data shows that allo-HSCT is still a useful option for treating selected patients with R/R B-NHL. Our retrospective analysis and review of the literature demonstrate that allo-HSCT can provide durable remissions in a subset of patients with R/R B-NHL.
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Affiliation(s)
- Santiago Mercadal
- Transplant and Cellular Therapy Program, Huntsman Cancer Institute, University of Utah, Utah, USA.
- Cellular Therapy and Regenerative Medicine, University of Utah, Utah, USA.
| | - Alberto Mussetti
- Bone Marrow Transplant and Cellular Therapy Unit, Catalan Institute of Oncology, Hospital Duran I Reynals, Barcelona, Spain
| | - Catherine J Lee
- Transplant and Cellular Therapy Program, Huntsman Cancer Institute, University of Utah, Utah, USA
| | - Carolina Arevalo
- Bone Marrow Transplant and Cellular Therapy Unit, Catalan Institute of Oncology, Hospital Duran I Reynals, Barcelona, Spain
| | - Silvina M Odstrcil
- Transplant and Cellular Therapy Program, Huntsman Cancer Institute, University of Utah, Utah, USA
| | - Esteban Peña
- Transplant and Cellular Therapy Program, Huntsman Cancer Institute, University of Utah, Utah, USA
| | - Anna Sureda
- Bone Marrow Transplant and Cellular Therapy Unit, Catalan Institute of Oncology, Hospital Duran I Reynals, Barcelona, Spain
| | - Daniel R Couriel
- Transplant and Cellular Therapy Program, Huntsman Cancer Institute, University of Utah, Utah, USA
- Cellular Therapy and Regenerative Medicine, University of Utah, Utah, USA
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3
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Cabrero M, López-Corral L, Jarque I, de la Cruz-Vicente F, Pérez-López E, Valcárcel D, Sanz J, Espigado I, Ortí G, Martín-Calvo C, de la Serna J, Caballero D. Ofatumumab as part of reduced intensity conditioning in high risk B-cell lymphoma patients: final long-term analysis from a prospective multicenter Phase-II Trial. Bone Marrow Transplant 2024; 59:359-365. [PMID: 38167647 DOI: 10.1038/s41409-023-02171-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/14/2023] [Accepted: 11/30/2023] [Indexed: 01/05/2024]
Abstract
Curative potential of allogeneic transplantation (AlloSCT) in high-risk non-Hodgkin lymphoma (NHL) could be enhanced by the integration of Ofatumumab (OFA), a 2nd generation anti-CD20 moAb, due to an antitumor effect and a role over graft-versus-host disease (GVHD). In this phase II trial (NCT01613300), we investigated safety and effectiveness of OFA-based reduced intensity conditioning (RIC). High-risk B-cell NHL patients with chemorrefractory disease or post-autologous SCT relapse were eligible. OFA was added to a standard RIC regimen. Primary endpoint was grade 3-4 aGVHD rate, while secondary endpoints included CR and survival rates. Thirty-three patients were included (median age 51; diffuse large B-cell:68%, HLA-identical donor: 74%). No grade >2 OFA toxicity was observed. Acute GVHD affected 77% of patients (16% grade 3-4). Remarkably, GVHD achieved CR in 75% of patients after first-line treatment. Chronic GVHD, primarily mild or moderate, occurred in 54% of patients. NHL CR rate at day +100 was 81%. Relapses occurred in 7 patients after a median of 3 months. Causes of death were lymphoma progression (5), infections (10), and GVHD (2). At 24 months, progression-free and overall survival rates were 50.1 and 51.6% respectively. OFA-RIC regimen is safe and effective, though acute GVHD remains a significant complication. However, data suggest that OFA could mitigate its severity.
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Affiliation(s)
- Mónica Cabrero
- Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain.
| | | | - Isidro Jarque
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | | | | | - Jaime Sanz
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
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4
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Watanabe M, Kanda J, Fukuda T, Uchida N, Ikegame K, Kataoka K, Kobayashi H, Ara T, Ishikawa J, Matsuoka KI, Sugio Y, Nakazawa H, Ikeda T, Atsuta Y, Kondo E, Suzuki R. Impact of GVHD on lymphoma progression: Nationwide study from Japanese Society for Transplantation and Cellular Therapy. Br J Haematol 2023; 203:446-459. [PMID: 37614023 DOI: 10.1111/bjh.19041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/23/2023] [Accepted: 08/03/2023] [Indexed: 08/25/2023]
Abstract
The graft-versus-lymphoma (GVL) effect and its association with acute and chronic GVHD (aGVHD, cGVHD) has not been comprehensively elucidated. We retrospectively analysed 2204 Japanese patients with non-Hodgkin lymphomas (NHLs; indolent B-NHLs, n = 689; aggressive B-NHLs, n = 720; mature T/NK-NHLs, n = 795) receiving a first allo-HSCT in 2003-2017. Pre-transplant lymphoma control showed complete response (CR) in 759 and non-CR in 1445. We assessed the impact of aGVHD/cGVHD on lymphoma progression and other outcomes. Although aGVHD/cGVHD showed no statistical impact on lymphoma progression in the overall cohort, their impact was clear in certain groups: Grade I-II aGVHD in CR patients (HR, 0.63; 95% CI, 0.43-0.91), especially in mature T/NK-NHL (HR, 0.46; 95% CI, 0.26-0.83) and extensive cGVHD in patients with mature aggressive B-NHLs (HR, 0.55; 95% CI, 0.31-0.97). In total, limited cGVHD was associated with superior survivals (progression-free survival: HR, 0.71; 95% CI, 0.56-0.90), whereas severe GVHDs showed negative impacts on them. Our results support the presence of GVL effects differentially associated with GVHD in different lymphoma subtypes/controls. Meanwhile, it was also suggested that we should manage GVHDs within a limited activity, considering the negative impact of severe GVHDs. As pre-transplant lymphoma control remains a strong factor influencing transplant outcomes, improving its management is an important issue to be addressed.
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Affiliation(s)
- Mizuki Watanabe
- Department of Hematology, Kyoto University Hospital, Kyoto, Japan
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Junya Kanda
- Department of Hematology, Kyoto University Hospital, Kyoto, Japan
| | - Takahiro Fukuda
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Naoyuki Uchida
- Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital, Tokyo, Japan
| | - Kazuhiro Ikegame
- Department of Hematology, Hyogo College of Medicine Hospital, Tokyo, Japan
| | - Keisuke Kataoka
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
- Division of Molecular Oncology, National Cancer Center Research Institute, Tokyo, Japan
| | - Hikaru Kobayashi
- Department of Hematology, Nagano Red Cross Hospital, Nagano, Japan
| | - Takahide Ara
- Department of Hematology, Hokkaido University Hospital, Sapporo, Japan
| | - Jun Ishikawa
- Department of Hematology, Osaka International Cancer Institute, Osaka, Japan
| | - Ken-Ichi Matsuoka
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Yasuhiro Sugio
- Kitakyushu City Hospital Organization, Kitakyushu Municipal Medical Center, Kitakyushu, Japan
| | - Hideyuki Nakazawa
- Department of Hematology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takashi Ikeda
- Division of Hematology and Stem Cell Transplantation, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan
- Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Eisei Kondo
- Department of Hematology, Kawasaki Medical School, Izumo, Japan
| | - Ritsuro Suzuki
- Department of Oncology and Hematology, Shimane University Hospital, Izumo, Japan
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5
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Avenoso D, Alabdulwahab A, Kenyon M, Mehra V, Krishnamurthy P, Dazzi F, Leung YT, Anteh S, Shah MN, Kuhnl A, Sanderson R, Patten P, Yallop D, Pagliuca A, Potter V. Fludarabine-Melphalan-Campath, Followed by Unmanipulated Peripheral-Blood Haematopoietic Stem Cells, Can Still Cure Lymphoma. Mediterr J Hematol Infect Dis 2023; 15:e2023041. [PMID: 37435036 PMCID: PMC10332350 DOI: 10.4084/mjhid.2023.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 06/18/2023] [Indexed: 07/13/2023] Open
Abstract
Background The second decade of this millennium was characterized by a widespread availability of chimeric antigen receptor T-cell (CAR-T) therapies to treat relapsed and refractory lymphomas. As expected, the role and indication of allogeneic haematopoietic stem cell transplant (allo-HSCT) in the management of lymphoma changed. Currently, a non-neglectable proportion of patients will be considered candidate for an allo-HSCT, and the debate of which transplant platform should be offered is still active. Objectives to report the outcome of patients affected with relapsed/refractory lymphoma and transplanted following reduced intensity conditioning at King's College Hospital, London, between January 2009 and April 2021. Methods Conditioning was with 150mg/m2 of fludarabine and melphalan of 140mg/m2. The graft was unmanipulated G-CSF mobilized peripheral blood haematopoietic stem cells (PBSC). Graft-versus-host disease (GVHD) prophylaxis consisted of pre-transplant Campath at the total dose of 60 mg in unrelated donors and 30 mg in fully matched sibling donors and ciclosporin. Results One-year and five years OS were 87% and 79.9%, respectively, and median OS was not reached. The cumulative incidence of relapse was 16%. The incidence of acute GVHD was 48% (only grade I/II); no cases of grade III/IV were diagnosed. Chronic GVHD occurred in 39% of patients. TRM was 12%, with no cases developed within day 100 and 18 months after the procedure. Conclusions The outcomes of heavily pretreated lymphoma patients are favorable, with median OS and survival not reached after a median of 49 months. In conclusion, even if some lymphoma subgroups cannot be treated (yet) with advanced cellular therapies, this study confirms the role of allo-HSCT as a safe and curative strategy.
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Affiliation(s)
- Daniele Avenoso
- King's College Hospital NHS Foundation Trust, Department of Haematological medicine, Denmark Hill, London
| | - Amal Alabdulwahab
- King's College Hospital NHS Foundation Trust, Department of Haematological medicine, Denmark Hill, London
| | - Michelle Kenyon
- King's College Hospital NHS Foundation Trust, Department of Haematological medicine, Denmark Hill, London
| | - Varun Mehra
- King's College Hospital NHS Foundation Trust, Department of Haematological medicine, Denmark Hill, London
| | - Pramila Krishnamurthy
- King's College Hospital NHS Foundation Trust, Department of Haematological medicine, Denmark Hill, London
| | - Francesco Dazzi
- King's College Hospital NHS Foundation Trust, Department of Haematological medicine, Denmark Hill, London
| | - Ye Ting Leung
- King's College Hospital NHS Foundation Trust, Department of Haematological medicine, Denmark Hill, London
| | - Sandra Anteh
- King's College Hospital NHS Foundation Trust, Department of Haematological medicine, Denmark Hill, London
| | - Mili Naresh Shah
- King's College Hospital NHS Foundation Trust, Department of Haematological medicine, Denmark Hill, London
| | - Andrea Kuhnl
- King's College Hospital NHS Foundation Trust, Department of Haematological medicine, Denmark Hill, London
| | - Robin Sanderson
- King's College Hospital NHS Foundation Trust, Department of Haematological medicine, Denmark Hill, London
| | - Piers Patten
- King's College Hospital NHS Foundation Trust, Department of Haematological medicine, Denmark Hill, London
| | - Deborah Yallop
- King's College Hospital NHS Foundation Trust, Department of Haematological medicine, Denmark Hill, London
| | - Antonio Pagliuca
- King's College Hospital NHS Foundation Trust, Department of Haematological medicine, Denmark Hill, London
| | - Victoria Potter
- King's College Hospital NHS Foundation Trust, Department of Haematological medicine, Denmark Hill, London
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6
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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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7
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Alsajri A, Shubber M, Al-Qerem W. Cross-allergic reactions between etoposide and penicillin in autologous bone marrow transplant patient. IRAQI JOURNAL OF HEMATOLOGY 2022. [DOI: 10.4103/ijh.ijh_25_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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8
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Gutiérrez-García G, Martínez C, Boumendil A, Finel H, Malladi R, Afanasyev B, Tsoulkani A, Wilson KMO, Bloor A, Nikoloudis M, Richardson D, López-Corral L, Castagna L, Cornelissen J, Giltat A, Collin M, Fanin R, Bonifazi F, Robinson S, Montoto S, Peggs KS, Sureda A. Long-term outcome of patients receiving haematopoietic allogeneic stem cell transplantation as first transplant for high-risk Hodgkin lymphoma: a retrospective analysis from the Lymphoma Working Party-EBMT. Br J Haematol 2021; 196:1018-1030. [PMID: 34750806 DOI: 10.1111/bjh.17939] [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: 06/07/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 11/30/2022]
Abstract
We analysed long-term outcome of patients receiving haematopoietic allogeneic stem cell transplantation (allo-HSCT) as a first transplant for high-risk Hodgkin lymphoma (HL). One hundred and ninety patients were included in this study, 63% of them had previously received brentuximab vedotin and/or checkpoint inhibitors. Seventy patients (37%) received an unrelated donor allo-HSCT, 99 (51%) had myeloablative conditioning (MAC) and 60% had in vivo T-cell/depleted grafts (TCD). The 100-day cumulative incidence (CI) of grade II-IV acute graft-versus-host disease (GVHD) was 25% and the 3-year CI of chronic GVHD was 38%. The 3-year CI of non-relapse mortality (NRM) and relapse rate were 21% and 38% respectively. After a median follow-up of 58 months, 3-year overall survival (OS) and progression-free survival (PFS) were 58% and 41% respectively. Multivariate analysis showed that, in comparison to reduced-intensity conditioning regimens with or without TCD, MAC using TCD had similar NRM and a lower risk of relapse leading to significantly better OS and PFS. MAC without TCD was associated with higher NRM and worse survival outcomes. These results suggest that in patients with high-risk HL and candidates of allo-HSCT, a MAC strategy with TCD might be the best option.
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Affiliation(s)
- G Gutiérrez-García
- Department of Haematology, Bone Marrow Transplantation Unit, Hospital Clinic of Barcelona, University of Barcelona, Institut de Recerca Biomèdica August Pi i Sunyer, Barcelona, Spain
| | - C Martínez
- Department of Haematology, Bone Marrow Transplantation Unit, Hospital Clinic of Barcelona, University of Barcelona, Institut de Recerca Biomèdica August Pi i Sunyer, Barcelona, Spain
| | | | - H Finel
- Lymphoma Working Party, EBMT, Paris, France
| | - R Malladi
- School of Cancer Sciences, University of Birmingham, Centre for Clinical Haematology, Queen Elizabeth NHS Foundation Trust, Birmingham, UK
| | - B Afanasyev
- State Medical Pavlov University, St. Petersburg, Russia
| | | | | | - A Bloor
- Haematology and Transplant Unit, Christie Hospital NHS Foundation Trust and University of Manchester, Manchester, UK
| | - M Nikoloudis
- Haematology Department Heart of England NHS Trust, Birmingham, UK
| | - D Richardson
- Department of Haematology, Southampton General Hospital, Southampton, UK
| | | | - L Castagna
- Department of Haematology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - J Cornelissen
- Erasmus MC Cancer Institute University Medical Centre Rotterdam Department of Haematology, Rotterdam, Netherlands
| | - A Giltat
- Department of Haematology, Medical University Hospital, Angers, France
| | | | - R Fanin
- Department of Haematology and Cellular Therapy 'Carlo Melzi', S. Maria della Misericordia University Hospital, DAME, University of Udine, Udine, Italy
| | - F Bonifazi
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
| | - S Robinson
- Department of Haematology and Oncology, Bristol University Hospital, Bristol, UK
| | - S Montoto
- St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - K S Peggs
- Department of Haematology, University College London Cancer Institute, London, UK
| | - A Sureda
- Clinical Department of Haematology, Institut Català d'Oncologia-Hospitalet, IDIBELL, University of Barcelona, Barcelona, Spain
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9
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Khouri IF, Milton DR, Gulbis AM, Jabbour EJ, Nastoupil L, Ledesma C, Anderlini P, Bashir Q, Daher M, Im JS, Iyer SP, Marin D, Mehta RS, Olson AL, Popat UR, Qazilbash M, Saini N, Samaniego F, Rondon G, Medeiros LJ, Champlin RE. Nine-Year Follow-up of Patients with Relapsed Follicular Lymphoma after Nonmyeloablative Allogeneic Stem Cell Transplant and Autologous Transplant. Clin Cancer Res 2021; 27:5847-5856. [PMID: 34380640 DOI: 10.1158/1078-0432.ccr-21-1377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/27/2021] [Accepted: 07/30/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE To compare outcomes between patients with relapsed follicular lymphoma who received a nonmyeloablative allogeneic stem cell transplant (alloSCT) and those who received an autologous transplant (autoSCT). PATIENTS AND METHODS We evaluated 194 patients with follicular lymphoma who received an alloSCT (n = 98) or autoSCT (n = 96) at MD Anderson Cancer Center (Houston, TX). The transplant type used was based on donor availability and by Medicare reimbursement guidelines. Patients who received an alloSCT were enrolled in four consecutive trials in which they received fludarabine, cyclophosphamide (or bendamustine), and rituximab conditioning. autoSCT patients received R-BEAM (rituximab, carmustine, etoposide, cytarabine, and melphalan). RESULTS The median follow-up of survivors was 108 months for the alloSCT group and 102 months for the autoSCT group. Overall survival was significantly better for patients who received an alloSCT compared with those who received an autoSCT (62% vs. 46%; P = 0.048). Similarly, progression-free survival rates were 52% in patients who received an alloSCT and 31% in those who received an autoSCT (P < 0.001), and the 8-year relapse rates were 11% and 43%, respectively (P < 0.0001). Only three patients in the alloSCT group relapsed beyond 3.5 years. In the alloSCT group, the rates for grade 2 to 4 acute graft-versus-host disease (GVHD), grade 3 to 4 acute GVHD, and extensive chronic GVHD were 22%, 9%, and 38%, respectively. In the autoSCT group, the 8-year incidence of secondary myelodysplasia was 11%. Nonrelapse mortality was similar between the two groups (15% vs. 11% at 8 years; P = 0.27). CONCLUSIONS This study shows that alloSCT is curative and confers superior survival compared with autoSCT in patients with follicular lymphoma.
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Affiliation(s)
- Issa F Khouri
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Denái R Milton
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alison M Gulbis
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Elias J Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Loretta Nastoupil
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Celina Ledesma
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Paolo Anderlini
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Qaiser Bashir
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - May Daher
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jin S Im
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Swaminathan P Iyer
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David Marin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rohtesh S Mehta
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Amanda L Olson
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Uday R Popat
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Muzaffar Qazilbash
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Neeraj Saini
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Felipe Samaniego
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gabriela Rondon
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Richard E Champlin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
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10
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Wang J, Duan X, Yang L, Liu X, Hao C, Dong H, Gu H, Tang H, Dong B, Zhang T, Gao G, Liang R. Comparison of Survival Between Autologous and Allogeneic Stem Cell Transplantation in Patients with Relapsed or Refractory B-Cell Non-Hodgkin Lymphoma: A Meta-Analysis. Cell Transplant 2021; 29:963689720975397. [PMID: 33238731 PMCID: PMC7784574 DOI: 10.1177/0963689720975397] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
This study aimed to compare the efficacy of allogeneic stem cell transplantation (allo-SCT) versus autologous SCT (auto-SCT) in patients with relapsed or refractory B-cell non-Hodgkin lymphoma (B-NHL). Medline, CENTRAL, and EMBASE databases through December 31, 2019 were searched. The primary endpoints were overall survival (OS) and progression-free survival (PFS) rates. The secondary outcomes include transplant-related mortality (TRM), event-free survival, relapse/or progression, and nonrelapse mortality (NRM). The 18 retrospective studies enrolled 8,058 B-NHL patients (allo-SCT = 1,204; auto-SCT = 6,854). The OS was significantly higher in patients receiving auto-SCT than allo-SCT (pooled odds ratio [OR]: 1.69, 95% confidence interval [CI]: 1.29 to 2.22, P < 0.001), but no significant difference was found in PFS (pooled OR: 0.98, 95% CI: 0.69 to 1.38, P = 0.891). Auto-SCT patients also had lower TRM and NRM (TRM: OR = 0.23, P < 0.001; NRM: OR = 0.16, P < 0.001), but higher relapse or progression rate (OR = 2.37, P < 0.001) than allo-SCT patients. Subgroup analysis performed for different grades and subtypes of B-NHL showed higher OS in auto-SCT patients with high-grade B-NHL and diffused large B-cell lymphoma (DLBCL). There was, nevertheless, higher PFS in allo-SCT patients with low-grade B-NHL and follicular lymphoma (FL), and lower PFS in allo-SCT patients with DLBCL than their auto-SCT counterparts. In conclusion, the meta-analysis demonstrated that relapsed or refractory B-NHL patients who received auto-SCT have improved OS than those treated with allo-SCT, especially among those with DLBCL, but lower PFS among those with FL. However, the study is limited by a lack of randomized trials, patients’ heterogeneity, and possible selection bias.
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Affiliation(s)
- Jianhong Wang
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Shaanxi Province, Xi'an, China
| | - Xiaohui Duan
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Shaanxi Province, Xi'an, China
| | - Lijie Yang
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Shaanxi Province, Xi'an, China
| | - Xiangxiang Liu
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Shaanxi Province, Xi'an, China
| | - Caixia Hao
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Shaanxi Province, Xi'an, China
| | - Hongjuan Dong
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Shaanxi Province, Xi'an, China
| | - Hongtao Gu
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Shaanxi Province, Xi'an, China
| | - Hailong Tang
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Shaanxi Province, Xi'an, China
| | - Baoxia Dong
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Shaanxi Province, Xi'an, China
| | - Tao Zhang
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Shaanxi Province, Xi'an, China
| | - Guangxun Gao
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Shaanxi Province, Xi'an, China
| | - Rong Liang
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Shaanxi Province, Xi'an, China
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11
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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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12
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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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13
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Allogeneic hematopoietic stem cell transplant for relapsed and refractory non-Hodgkin lymphoma in pediatric patients. Blood Adv 2020; 3:2689-2695. [PMID: 31511228 DOI: 10.1182/bloodadvances.2018026203] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 04/25/2019] [Indexed: 11/20/2022] Open
Abstract
Allogeneic hematopoietic stem cell transplant (HSCT) for relapsed pediatric non-Hodgkin lymphoma (NHL) is often reserved for patients with certain NHL subtypes or high-risk disease whereas the remainder receive autologous HSCT. Given the aggressive nature of pediatric NHL, we performed allogeneic HSCTs for all patients regardless of disease risk. We report overall survival (OS) and prognostic variables in 36 pediatric patients who underwent allogeneic HSCT between 1998 and 2016. OS at 3 years was 67%. The 3-year OS varied based on NHL subtype: 100% for anaplastic large cell lymphoma (n = 14), 63% for diffuse large B-cell lymphoma (n = 8), 17% for lymphoblastic lymphoma (LL; n = 9) and 80% for other subtypes combined (n = 5). Disease status influenced outcome with 3-year OS of 100% for patients in complete remission (n = 15), 59% with partial remission (PR; n = 17), and 0% with progressive/stable disease (n = 3) (P = .004). Of the 17 patients in PR, all 6 with LL died of relapsed disease, whereas the other 11 attained remission after HSCT and remained disease-free. The cumulative incidence of relapse after HSCT for LL was 78% compared with 15% for all other NHL subtypes combined (P < .0001). Cumulative incidence of nonrelapse mortality (NRM) was low in our cohort at 6%. Hence, allogeneic HSCT is a well-tolerated and useful therapeutic option with low rates of NRM and relapse for all NHL subtypes except LL with active disease at HSCT.
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14
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Impact of Rituximab and Host/Donor Fc Receptor Polymorphisms after Allogeneic Hematopoietic Cell Transplantation for CD20 + B Cell Malignancies. Biol Blood Marrow Transplant 2020; 26:1811-1818. [PMID: 32693210 DOI: 10.1016/j.bbmt.2020.07.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/11/2020] [Accepted: 07/13/2020] [Indexed: 11/22/2022]
Abstract
We previously reported a 24% 1-year relapse rate in 93 older or medically unfit patients with CD20+ B cell malignancies after allogeneic hematopoietic cell transplantation (HCT) with low-intensity conditioning. The current prospective study tested the hypothesis that disease relapse could be reduced and overall survival (OS) improved by peritransplantation administration of rituximab (RTX). Sixty-three patients received RTX (375 mg/m2/day) on days -3, +10, +24, and +38 along with 2 to 3 Gy total body irradiation with or without fludarabine (30 mg/m2 for 3 days). Median RTX levels of >25 μg/mL were achieved through day +84 after transplantation, but RTX level was not correlated with relapse or graft-versus-host disease (GVHD). HCT recipients with F/F and V/F FCγRIIIa polymorphisms showed a trend toward a higher relapse rate compared with those with V/V polymorphism (P= .15). No difference in outcome was found based on V/V donor pairing. Five-year relapse rates were similar between RTX-treated patients and historical controls (32% versus 28%; P = .94). RTX-treated patients had greater 5-year OS (47% versus 38%; P = .13) and progression-free survival (41% versus 32%; P = .12) compared with historical controls who underwent HCT without RTX, although the difference was not statistically significant. The incidence of acute GVHD was similar in the 2 groups (grade II-IV, 57% versus 56%; grade III-IV, 13% versus 17%), but the 5-year incidence of chronic GVHD was higher among RTX-treated patients (62% versus 47%). In patients with relapsed or refractory non-Hodgkin lymphoma, peritransplantation RTX neither reduced relapse nor improved GVHD. The role of donor-recipient pairing by FCγRIIIa polymorphisms in outcomes remains to be determined.
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15
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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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16
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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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17
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Challenges and Opportunities for High-grade B-Cell Lymphoma With MYC and BCL2 and/or BCL6 Rearrangement (Double-hit Lymphoma). Am J Clin Oncol 2019; 42:304-316. [PMID: 29419530 DOI: 10.1097/coc.0000000000000427] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The most common subtype of non-Hodgkin lymphoma, diffuse large B-cell lymphoma, is cured in approximately two thirds of patients after initial therapy. The remaining one-third of patients who suffer relapse or become refractory have very poor survival outcomes despite salvage chemotherapy with or without stem cell transplantation. A considerable proportion of relapsed or refractory large B cells belong to the WHO subtype known as high-grade B-cell lymphoma with rearrangement of MYC and BCL2 and/or BCL6, also known as double-hit lymphoma (DHL). Most DHL patients present with Ann Arbor's stage III/IV, a comparatively higher rate of extranodal involvement including bone marrow and central nervous system infiltration, high levels of lactate dehydrogenase, and an elevated Ki67 expression in the tumor cells. Newer therapeutic approaches, including targeted therapy against BCL2, MYC, or other associated pathways, are needed. In addition, recent therapies that harness the immune system, such as checkpoint inhibitors and chimeric antigen receptor T-cell therapy, are changing the paradigm of treatment for non-Hodgkin lymphoma and could impact the outcome of DHL.
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18
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Phuoc V, Sandoval-Sus J, Chavez JC. Drug therapy for double-hit lymphoma. Drugs Context 2019; 8:dic-8-2019-8-1. [PMID: 31844420 PMCID: PMC6905641 DOI: 10.7573/dic.2019-8-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/15/2019] [Accepted: 10/17/2019] [Indexed: 12/19/2022] Open
Abstract
Double-hit lymphoma (DHL) is a rare type of aggressive B-cell lymphoma defined as a high-grade B-cell lymphoma (HGBCL) with the presence of MYC, BCL2 and/or BCL6 rearrangements. Patients usually present with rapidly progressive and advanced stage of disease and, commonly, with extranodal involvement. Typically, patients become refractory to standard R-CHOP, and more aggressive regimens such as DA-EPOCH-R, R-hyperCVAD or CODOX-R regimens are typically needed. MYC is considered an “undruggable” mutation. Recent evidence suggests that pathogenic mechanisms associated with MYC could be potential targets. In this review, we also discuss the role of hematopoietic stem cell transplantation (HCT) and chimeric antigen receptor (CAR) T-cell therapy in DHL. We also discuss the role of potential novel agents such as BCL2 inhibitors, checkpoint inhibitors, bromodomain and extraterminal (BET) family inhibitors, Pi3K inhibitors, and others.
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Affiliation(s)
- Vania Phuoc
- Division Hematology/Oncology, University of South Florida, Tampa, FL, USA
| | - Jose Sandoval-Sus
- Department of Malignant Hematology and Cellular Therapy at Memorial Healthcare System, Pembroke Pines, FL, USA
| | - Julio C Chavez
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa FL, USA
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19
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Emergency general surgery procedures in hematopoietic stem cell transplant recipients. Am J Surg 2019; 218:972-977. [PMID: 30862354 DOI: 10.1016/j.amjsurg.2019.02.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 01/26/2019] [Accepted: 02/18/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Outcomes of emergency general surgery (EGS) procedures on hematopoietic stem cell transplant (HST) recipients have not been defined in a large, national database. Whether EGS during HST engraftment admission, or in HST patients with graft versus host disease (GVHD) results in worse outcomes is unknown. METHODS The National Inpatient Sample (NIS) was examined for patients with a history of BMT between 2001 and 2014. RESULTS There were 520,000 HST admissions meeting inclusion criteria, of which, 14,143 (2.7%) required EGS. Of those requiring EGS, 378 (2.7%) were during engraftment admission and 13,765 (97.3%) on subsequent admission. For those requiring EGS during subsequent admission, 9,920 (72.1%) had a history of GVHD and 3,845 (27.9%) did not. On multivariate analysis, requirement of EGS was associated with mortality (OR: 1.71, 95%CI: 1.47-1.99, p < 0.001). For patients requiring EGS, engraftment admission or GVHD was not associated with mortality. CONCLUSIONS While EGS results in worse survival for the HST population, patients in their engraftment admission do not appear to be at increased mortality risk. In addition, GVHD does not worsen survival.
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20
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Saini NY, Saliba RM, Rondon G, Maadani F, Popat U, Hosing CM, Oran B, Bashir Q, Olson A, Nieto Y, Alousi A, Kebriaei P, Srour S, Mehta R, Anderlini P, Shpall EJ, Qazilbash MH, Khouri IF, Fayad L, Lee H, Fowler N, Parmar S, Westin J, Hagemeister F, Champlin RE, Ciurea SO. Impact of Donor Type and Melphalan Dose on Allogeneic Transplantation Outcomes for Patients with Lymphoma. Biol Blood Marrow Transplant 2019; 25:1340-1346. [PMID: 30763728 DOI: 10.1016/j.bbmt.2019.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 02/04/2019] [Indexed: 12/11/2022]
Abstract
We analyzed 186 patients with lymphoma who underwent allogeneic stem cell transplantation (ASCT) with fludarabine-melphalan (FM) conditioning and different types of donors (25 haploidentical [HD], 98 matched unrelated [MUD], and 63 matched related [MRD]) at our institution between September 2009 and January 2018. Patients received fludarabine 160 mg/m2 (40 mg/m2/day for 4 days) in combination with 1 dose of melphalan 140 mg/m2 (FM140) or 100 mg/m2 (FM100). Engraftment was similar among the 3 groups (92%, 89%, and 98%, respectively; P = .7). The 6-month cumulative incidence of grade III-IV acute graft-versus-host disease (GVHD) was 4% in the HD group, 14% in the MUD group, and 8% in the MRD group (P not significant), and the respective 3-year cumulative incidence of chronic GVHD was 5%, 16%, and 26% (P not significant). The respective 3-year nonrelapse mortality and relapse rates were 31%, 32%, and 10% (HD versus MUD, P = .9; HD versus MRD, P = .02) and 15%, 21%, and 39% (HD versus MUD, P = .4; HD versus MRD, P = .04). At 3 years, progression-free survival (PFS) was 59%, 44%, and 46% (P not significant); overall survival (OS) was 52%, 54%, and 67% (P not significant); and GVHD-free, relapse-free survival was 39%, 31%, and 24% (P not significant). No differences in the 3-year PFS (57% versus 43%; P = .3) and OS (64% versus 58%; P = .7) were seen between patients receiving FM100 and those receiving FM140. Our data demonstrate that in patients with lymphoma, ASCT with HD transplants have similar outcomes as ASCT with HLA-matched transplants, and the FM100 conditioning regimen appears to be at least as effective as the FM140 regimen.
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Affiliation(s)
- Neeraj Y Saini
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Rima M Saliba
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Gabriela Rondon
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Farzaneh Maadani
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Uday Popat
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Chitra M Hosing
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Betul Oran
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Qaiser Bashir
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Amanda Olson
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Yago Nieto
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Amin Alousi
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Partow Kebriaei
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Samer Srour
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Rohtesh Mehta
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Paolo Anderlini
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Elizabeth J Shpall
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Muzaffar H Qazilbash
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Issa F Khouri
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Luis Fayad
- Department of Lymphoma and Myeloma, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Hun Lee
- Department of Lymphoma and Myeloma, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Nathan Fowler
- Department of Lymphoma and Myeloma, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Simrit Parmar
- Department of Lymphoma and Myeloma, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Jason Westin
- Department of Lymphoma and Myeloma, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Fredrick Hagemeister
- Department of Lymphoma and Myeloma, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Richard E Champlin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Stefan O Ciurea
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, Texas.
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21
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Fujita N, Kobayashi R, Atsuta Y, Iwasaki F, Suzumiya J, Sasahara Y, Inoue M, Koh K, Hori T, Goto H, Ichinohe T, Hashii Y, Kato K, Suzuki R, Mitsui T. Hematopoietic stem cell transplantation in children and adolescents with relapsed or refractory B-cell non-Hodgkin lymphoma. Int J Hematol 2019; 109:483-490. [PMID: 30701466 DOI: 10.1007/s12185-019-02608-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 01/19/2019] [Accepted: 01/23/2019] [Indexed: 01/03/2023]
Abstract
We undertook a retrospective study using the national registry data of hematopoietic stem cell transplantation (HSCT) in Japan to investigate the effect of graft source, particularly autologous or allogeneic tissue, on the treatment outcome in patients aged less than 18 years with relapsed or refractory B-cell non-Hodgkin lymphoma (B-NHL). Survival analysis was conducted on 31 autologous HSCT (auto-HSCT) and 48 allogeneic HSCT (allo-HSCT) recipients between 1990 and 2013. The 5-year survival rates were significantly lower for allo-HSCT compared to auto-HSCT recipients (32% vs. 55%; P = 0.036). Multivariate analysis of survival rates identified allogeneic graft, Burkitt histology, and lack of response to chemotherapy as poor prognostic factors for survival. The cumulative incidence of treatment-related mortality (TRM) was significantly higher in allo-HSCT compared to auto-HSCT recipients (P = 0.017), explaining the difference in survival rates. In patients with Burkitt lymphoma (BL), overall survival was significantly inferior in the group of patients undergoing HSCT within 12 months from the initial diagnosis (P = 0.039). These data indicate that treatment outcomes for HSCT in children and adolescents with B-NHL were better in autograft recipients, suggesting that greater attention should be paid to the risk of TRM, especially after allografts, for patients with BL.
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Affiliation(s)
- Naoto Fujita
- Department of Pediatrics, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, 1-9-6 Senda-Machi, Naka-ku, Hiroshima, 730-8619, Japan.
| | - Ryoji Kobayashi
- Department of Pediatrics, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Fuminori Iwasaki
- Department of Hematology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Junji Suzumiya
- Department of Oncology/Hematology, Shimane University Hospital, Izumo, Japan
| | - Yoji Sasahara
- Department of Pediatrics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masami Inoue
- Department of Hematology/Oncology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Katsuyoshi Koh
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan
| | - Tsukasa Hori
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hiroaki Goto
- Division of Hemato-Oncology/Regenerative Medicine, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Tatsuo Ichinohe
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Yoshiko Hashii
- Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Koji Kato
- Department of Hematology and Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Ritsuro Suzuki
- Department of Oncology and Hematology, Shimane University Hospital Cancer Center, Izumo, Japan
| | - Tetsuo Mitsui
- Department of Pediatrics, Yamagata University School of Medicine, Yamagata, Japan
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22
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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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23
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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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24
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Norman JE, Schouten HC, Dreger P, Robinson SP. The role of stem cell transplantation in the management of relapsed follicular lymphoma in the era of targeted therapies. Bone Marrow Transplant 2018; 54:787-797. [DOI: 10.1038/s41409-018-0372-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 09/21/2018] [Accepted: 09/24/2018] [Indexed: 02/06/2023]
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25
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Mannino RG, Pradhan P, Roy K, Lam WA. 3D in vitro microvascular model-based lymphoma model. Methods Cell Biol 2018; 146:149-158. [PMID: 30037459 DOI: 10.1016/bs.mcb.2018.05.007] [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] [Indexed: 12/28/2022]
Abstract
Diffuse large B-cell lymphoma (DLBCL) is a particularly aggressive cancer, impacting the lives of approximately 20,000 people annually in the United States. Elucidating cellular interactions that occur within the microenvironment of DLBCL tumors is crucial to the successful development of therapeutic strategies for this condition. As the in vivo microenvironment of DLBCL is quite complex and variable, in vitro platforms that can sufficiently recapitulate these multifaceted cellular interactions without introducing the complexities of in vivo systems are vital for understanding the pathophysiology of this disease. In this chapter, we present a method for fabrication and development of an in vitro DLBCL-on-chip model in which a fully vascularized, perfusable, microfluidic traverses a DLBCL tumor cell-laden hydrogel that successfully recapitulates hallmark attributes and cellular interaction that occur within the DLBCL tumor microenvironment. As this microfluidic approach makes use of common laboratory items and does not require traditional photolithography to fabricate, this system represents a vital tool that can unlock previously inaccessible research areas of the DLBCL tumor microenvironment to researchers across numerous fields.
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Affiliation(s)
- Robert G Mannino
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States; Department of Pediatrics, Division of Pediatric Hematology/Oncology Aflac Cancer Center and Blood Disorders Center of Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, United States
| | - Pallab Pradhan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States; Department of Pediatrics, Division of Pediatric Hematology/Oncology Aflac Cancer Center and Blood Disorders Center of Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, United States
| | - Krishnendu Roy
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States; Department of Pediatrics, Division of Pediatric Hematology/Oncology Aflac Cancer Center and Blood Disorders Center of Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, United States
| | - Wilbur A Lam
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States; Department of Pediatrics, Division of Pediatric Hematology/Oncology Aflac Cancer Center and Blood Disorders Center of Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, United States.
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26
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Sureda A, Zhang MJ, Dreger P, Carreras J, Fenske T, Finel H, Schouten H, Montoto S, Robinson S, Smith SM, Boumedil A, Hamadani M, Pasquini MC. Allogeneic hematopoietic stem cell transplantation for relapsed follicular lymphoma: A combined analysis on behalf of the Lymphoma Working Party of the EBMT and the Lymphoma Committee of the CIBMTR. Cancer 2018; 124:1733-1742. [PMID: 29424927 DOI: 10.1002/cncr.31264] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 12/01/2017] [Accepted: 12/29/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND Allogeneic hematopoietic stem cell transplantation (allo-HCT) remains the only potentially curative treatment option for relapsed follicular lymphoma (FL), yet questions remain about the optimal timing. This study analyzed long-term outcomes and associated factors among recipients of allo-HCT with FL. METHODS Patients with relapsed FL who underwent allo-HCT from 2001 to 2011 with a human leukocyte antigen (HLA)-matched donor were included. Outcome analyses for overall survival (OS), progression-free survival (PFS), transplant-related mortality (TRM), and disease relapse/progression were calculated. A multivariate analysis was performed to determine factors associated with outcomes, and a prognostic score for treatment failure was developed in a subset analysis of patients. RESULTS In all, 1567 patients with relapsed FL were included; the median follow-up was 55 months. The 5-year probabilities of OS and PFS were 61% and 52%, respectively. The 5-year cumulative incidences of disease progression/relapse and TRM were 29% and 19%, respectively. Chemoresistant disease, older age, heavy pretreatment, poor performance status (PS), and myeloablative protocols were predictors for worse survival. The prognostic score, using age, lines of prior therapy, disease status, and PS, stratified patients into 3 groups-low, intermediate, and high risk-with 5-year PFS rates of 68%, 53%, and 46%, respectively, and 5-year OS rates of 80%, 62%, and 50%, respectively. CONCLUSIONS Allo-HCT should be considered for patients with relapsed FL and available HLA-matched donors. Outcomes are better in earlier phases of the disease, and reduced-intensity conditioning should be preferred. The prognostic score presented here can assist in counseling patients and determining the time to proceed to transplantation. Cancer 2018;124:1733-42. © 2018 American Cancer Society.
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Affiliation(s)
- Anna Sureda
- Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain
| | - Mei-Jie Zhang
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
- Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Peter Dreger
- Universitaetsklinkum Heidelberg, Heidelberg, Germany
| | - Jeanette Carreras
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Timothy Fenske
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Herve Finel
- Central Registry Office, European Society for Blood and Marrow Transplantation, Paris, France
| | - Harry Schouten
- Department of Hematology, Academische Ziekenhuis, Maastricht, the Netherlands
| | - Silvia Montoto
- Department of Haemato-Oncology, St. Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | | | - Sonali M Smith
- Section of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - Ariane Boumedil
- Central Registry Office, European Society for Blood and Marrow Transplantation, Paris, France
| | - Mehdi Hamadani
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Marcelo C Pasquini
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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27
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Wever CM, Geoffrion D, Grande BM, Yu S, Alcaide M, Lemaire M, Riazalhosseini Y, Hébert J, Gavino C, Vinh DC, Petrogiannis-Haliotis T, Dmitrienko S, Mann KK, Morin RD, Johnson NA. The genomic landscape of two Burkitt lymphoma cases and derived cell lines: comparison between primary and relapse samples. Leuk Lymphoma 2018; 59:2159-2174. [PMID: 29295643 DOI: 10.1080/10428194.2017.1413186] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Relapse occurs in 10-40% of Burkitt lymphoma (BL) patients that have completed intensive chemotherapy regimens and is typically fatal. While treatment-naive BL has been characterized, the genomic landscape of BL at the time of relapse (rBL) has never been reported. Here, we present a genomic characterization of two rBL patients. The diagnostic samples had mutations common in BL, including MYC and CCND3. Additional mutations were detected at relapse, affecting important pathways such as NFκB (IKBKB) and MEK/ERK (NRAS) signaling, glutamine metabolism (SIRT4), and RNA processing (ZFP36L2). Genes implicated in drug resistance were also mutated at relapse (TP53, BAX, ALDH3A1, APAF1, FANCI). This concurrent genomic profiling of samples obtained at diagnosis and relapse has revealed mutations not previously reported in this disease. The patient-derived cell lines will be made available and, along with their detailed genetics, will be a valuable resource to examine the role of specific mutations in therapeutic resistance.
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Affiliation(s)
- Claudia M Wever
- a Department of Medicine , McGill University, Lady Davis Institute, Jewish General Hospital , Montreal , Canada.,b Lady Davis Institute, Jewish General Hospital , Montreal , Canada
| | | | - Bruno M Grande
- c Department of Molecular Biology and Biochemistry , Simon Fraser University , Burnaby , Canada.,d Genome Sciences Centre, BC Cancer Agency , Vancouver , Canada
| | - Stephen Yu
- c Department of Molecular Biology and Biochemistry , Simon Fraser University , Burnaby , Canada
| | - Miguel Alcaide
- c Department of Molecular Biology and Biochemistry , Simon Fraser University , Burnaby , Canada
| | - Maryse Lemaire
- b Lady Davis Institute, Jewish General Hospital , Montreal , Canada
| | - Yasser Riazalhosseini
- e Department of Human Genetics , McGill University , Montreal , Canada.,f McGill University and Genome Quebec Innovation Centre , Montreal , Canada
| | - Josée Hébert
- g Department of Medicine, Faculty of Medicine , Université de Montréal , Montreal , Canada.,h Research Centre and Division of Hematology-Oncology Maisonneuve-Rosemont Hospital , The Québec Leukemia Cell Bank , Montreal , Canada
| | - Christina Gavino
- i Infectious Disease Susceptibility Program (Research Institute-McGill University Health Centre) , Montreal , Canada.,j Department of Medicine , Medical Microbiology and Human Genetics (McGill University Health Centre) , Montreal , Canada
| | - Donald C Vinh
- i Infectious Disease Susceptibility Program (Research Institute-McGill University Health Centre) , Montreal , Canada.,j Department of Medicine , Medical Microbiology and Human Genetics (McGill University Health Centre) , Montreal , Canada
| | | | | | - Koren K Mann
- a Department of Medicine , McGill University, Lady Davis Institute, Jewish General Hospital , Montreal , Canada.,b Lady Davis Institute, Jewish General Hospital , Montreal , Canada
| | - Ryan D Morin
- c Department of Molecular Biology and Biochemistry , Simon Fraser University , Burnaby , Canada.,d Genome Sciences Centre, BC Cancer Agency , Vancouver , Canada
| | - Nathalie A Johnson
- a Department of Medicine , McGill University, Lady Davis Institute, Jewish General Hospital , Montreal , Canada.,b Lady Davis Institute, Jewish General Hospital , Montreal , Canada
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28
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29
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Treatment of sporadic Burkitt lymphoma in adults, a retrospective comparison of four treatment regimens. Ann Hematol 2017; 97:255-266. [PMID: 29209924 PMCID: PMC5754407 DOI: 10.1007/s00277-017-3167-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 11/03/2017] [Indexed: 11/25/2022]
Abstract
Burkitt lymphoma is an aggressive B cell malignancy accounting for 1–2% of all adult lymphomas. Treatment with dose-intensive, multi-agent chemotherapy is effective but associated with considerable toxicity. In this observational study, we compared real-world efficacy, toxicity, and costs of four frequently employed treatment strategies for Burkitt lymphoma: the Lymphome Malins B (LMB), the Berlin-Frankfurt-Münster (BFM), the HOVON, and the CODOX-M/IVAC regimens. We collected data from 147 adult patients treated in eight referral centers. Following central pathology assessment, 105 of these cases were accepted as Burkitt lymphoma, resulting in the following treatment groups: LMB 36 patients, BFM 19 patients, HOVON 29 patients, and CODOX-M/IVAC 21 patients (median age 39 years, range 14–74; mean duration of follow-up 47 months). There was no significant difference between age, sex ratio, disease stage, or percentage HIV-positive patients between the treatment groups. Five-year progression-free survival (69%, p = 0.966) and 5-year overall survival (69%, p = 0.981) were comparable for all treatment groups. Treatment-related toxicity was also comparable with only hepatotoxicity seen more frequently in the CODOX/M-IVAC group (p = 0.004). Costs were determined by the number of rituximab gifts and the number of inpatients days. Overall, CODOX-M/IVAC had the most beneficial profile with regards to costs, treatment duration, and percentage of patients completing planned treatment. We conclude that the four treatment protocols for Burkitt lymphoma yield nearly identical results with regards to efficacy and safety but differ in treatment duration and costs. These differences may help guide future choice of treatment.
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30
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Gauthier J, Chantepie S, Bouabdallah K, Jost E, Nguyen S, Gac AC, Damaj G, Duléry R, Michallet M, Delage J, Lewalle P, Morschhauser F, Salles G, Yakoub-Agha I, Cornillon J. [Allogeneic haematopoietic cell transplantation for indolent lymphomas: Guidelines from the Francophone Society Bone Marrow Transplantation and Cellular Therapy (SFGM-TC)]. Bull Cancer 2017; 104:S121-S130. [PMID: 29173973 DOI: 10.1016/j.bulcan.2017.05.010] [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: 04/20/2017] [Accepted: 05/01/2017] [Indexed: 10/18/2022]
Abstract
Despite great improvements in the outcome of patients with lymphoma, some may still relapse or present with primary refractory disease. In these situations, allogeneic hematopoietic cell transplantation is a potentially curative option, this is true particularly the case of relapse after autologous stem cell transplantation. Recently, novel agents such as anti-PD1 and BTK inhibitors have started to challenge the use of allogeneic hematopoietic cell transplantation for relapsed or refractory lymphoma. During the 2016 annual workshop of the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC), we performed a comprehensive review of the literature published in the last 10 years and established guidelines to clarify the indications and transplant modalities in this setting. This paper specifically reports on our conclusions regarding indolent lymphomas, mainly follicular lymphoma and chronic lymphocytic leukemia.
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Affiliation(s)
- Jordan Gauthier
- CHRU de Lille, pôle spécialités médicales et gérontologie, service des maladies du sang, secteur allogreffe de cellules souches hématopoïétiques, 59037 Lille, France; Université de Lille, UFR médecine, 59000 Lille, France
| | - Sylvain Chantepie
- AP-HP, hôpital La Pitié-Salpêtrière, service d'hématologie, 75013 Paris, France
| | | | - Edgar Jost
- Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne
| | | | - Anne-Claire Gac
- AP-HP, hôpital La Pitié-Salpêtrière, service d'hématologie, 75013 Paris, France
| | - Gandhi Damaj
- AP-HP, hôpital La Pitié-Salpêtrière, service d'hématologie, 75013 Paris, France
| | - Rémy Duléry
- AP-HP, hôpital Saint-Antoine, service d'hématologie, 75012 Paris, France
| | | | - Jérémy Delage
- CHU de Montpellier, service d'hématologie, 34295 Montpellier, France
| | - Philippe Lewalle
- Université libre de Bruxelles, institut Jules-Bordet, service d'hématologie, Bruxelles, Belgique
| | - Franck Morschhauser
- CHRU de Lille, pôle spécialités médicales et gérontologie, service des maladies du sang, secteur allogreffe de cellules souches hématopoïétiques, 59037 Lille, France; Université de Lille, UFR médecine, 59000 Lille, France
| | - Gilles Salles
- CHU de Lyon, service d'hématologie, 69310 Pierre-Bénite, France
| | - Ibrahim Yakoub-Agha
- CHRU de Lille, pôle spécialités médicales et gérontologie, service des maladies du sang, secteur allogreffe de cellules souches hématopoïétiques, 59037 Lille, France; CHU de Lille, université de Lille2, LIRIC Inserm U995, 59000 Lille, France
| | - Jérôme Cornillon
- Institut de cancérologie Lucien-Neuwirth, département d'hématologie clinique, 42271 Saint-Priest-en-Jarez, France.
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31
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Hess G. The role of stem cell transplantation in follicular lymphoma. Best Pract Res Clin Haematol 2017; 31:31-40. [PMID: 29452664 DOI: 10.1016/j.beha.2017.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 10/27/2017] [Accepted: 10/31/2017] [Indexed: 12/14/2022]
Abstract
With the introduction of novel treatments paradigms to if or when to use transplantation strategies for patients with follicular lymphoma have changed substantially. Autologous transplantation has been intensively evaluated as consolidation after first induction treatment with positive effects, however the introduction of Rituximab led to comparable improvements and HDT has been moved to relapse treatment. In this indication HDT was frequently use already at first relapse, but now is dominantly used in patients with a highrisk profile, e.g. failure of response, early or multiply relapse and/or signs of transformation. The ideal place for allogeneic transplantation is even harder to define, as the curative potential might be outweighed by the substantial side effect profile and the indication must always be discussed in the light of available alternatives. In consequence, transplantation strategies remain an important therapeutic instrument for patients with FL, however timing within the treatment course has to be defined individually.
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Affiliation(s)
- Georg Hess
- Department of Hematology, Oncology and Pneumology, University Cancer Center Mainz, University Medical School of the Johannes Gutenberg-University, Langenbeckstr. 1, 55131 Mainz, Germany.
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32
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In Burkitt lymphoma patients who relapse after induction with a short-intensive chemoimmunotherapy protocol, aggressive salvage chemotherapy therapy is ineffective: a single-center retrospective study. Ann Hematol 2017. [PMID: 28623395 DOI: 10.1007/s00277-017-3044-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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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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Kharfan-Dabaja MA, El-Jurdi N, Ayala E, Kanate AS, Savani BN, Hamadani M. Is myeloablative dose intensity necessary in allogeneic hematopoietic cell transplantation for lymphomas? Bone Marrow Transplant 2017; 52:1487-1494. [PMID: 28368373 DOI: 10.1038/bmt.2017.55] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 12/21/2016] [Accepted: 01/08/2017] [Indexed: 12/25/2022]
Abstract
The advent of novel immunotherapy and tyrosine kinase inhibitors has ushered a new era in the treatment of Hodgkin and non-Hodgkin lymphomas. Allogeneic hematopoietic cell transplantation remains, however, a vital component in the management and potential cure of lymphomas, especially in the relapsed setting. Considering the biological and clinical heterogeneity of various subtypes of lymphomas, the optimal intensity of conditioning regimens remains controversial. Reduced intensity conditioning regimens have broadened applicability of the procedure to older and frail patients. Observational studies suggest that although reduced intensity allografting is associated with higher risk of relapse, overall survival is comparable and in some cases even better, than observed with myeloablative regimens. Here, we review the available published data pertaining to allogeneic hematopoietic cell transplantation using reduced intensity or myeloablative conditioning for various lymphoma histologies. Owing to the lack of randomized prospective trials, recommendations are mainly based on registry and single-institution studies. Special emphasis must be given to implementing strategies to prevent relapse when using reduced intensity regimens. Identifying particular patients who may benefit from myeloablative regimens in lymphomas remains to be better defined.
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Affiliation(s)
- M A Kharfan-Dabaja
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - N El-Jurdi
- Division of Hematology-Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - E Ayala
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - A S Kanate
- Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, WV, USA
| | - B N Savani
- Division of Hematology and Oncology and Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - M Hamadani
- Division of Hematology-Oncology, Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Mannino RG, Santiago-Miranda AN, Pradhan P, Qiu Y, Mejias JC, Neelapu SS, Roy K, Lam WA. 3D microvascular model recapitulates the diffuse large B-cell lymphoma tumor microenvironment in vitro. LAB ON A CHIP 2017; 17:407-414. [PMID: 28054086 PMCID: PMC5285444 DOI: 10.1039/c6lc01204c] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Diffuse large B-cell lymphoma (DLBCL) is an aggressive cancer that affects ∼22 000 people in the United States yearly. Understanding the complex cellular interactions of the tumor microenvironment is critical to the success and development of DLBCL treatment strategies. In vitro platforms that successfully model the complex tumor microenvironment without introducing the variability of in vivo systems are vital for understanding these interactions. To date, no such in vitro model exists that can accurately recapitulate the interactions that occur between immune cells, cancer cells, and endothelial cells in the tumor microenvironment of DLBCL. To that end, we developed a lymphoma-on-chip model consisting of a hydrogel based tumor model traversed by a vascularized, perfusable, round microchannel that successfully recapitulates key complexities and interactions of the in vivo tumor microenvironment in vitro. We have shown that the perfusion capabilities of this technique allow us to study targeted treatment strategies, as well as to model the diffusion of infused reagents spatiotemporally. Furthermore, this model employs a novel fabrication technique that utilizes common laboratory materials, and allows for the microfabrication of multiplex microvascular environments without the need for advanced microfabrication facilities. Through our facile microfabrication process, we are able to achieve micro vessels within a tumor model that are highly reliable and precise over the length of the vessel. Overall, we have developed a tool that enables researchers from many diverse disciplines to study previously inaccessible aspects of the DLBCL tumor microenvironment, with profound implications for drug delivery and design.
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Affiliation(s)
- Robert G Mannino
- The Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech and Emory University, Atlanta, GA, USA. and The Parker H. Petit Institute for Bioengineering and Biosciences, Georgia Institute of Technology, Atlanta, GA, USA and Emory University School of Medicine, Department of Pediatrics, Division of Pediatric Hematology/Oncology, Atlanta, GA, USA and Children's Healthcare of Atlanta, Aflac Cancer & Blood Disorders Center, Atlanta, GA, USA and Institute of Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA, USA
| | - Adriana N Santiago-Miranda
- The Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech and Emory University, Atlanta, GA, USA. and The Parker H. Petit Institute for Bioengineering and Biosciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - Pallab Pradhan
- The Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech and Emory University, Atlanta, GA, USA. and The Parker H. Petit Institute for Bioengineering and Biosciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - Yongzhi Qiu
- The Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech and Emory University, Atlanta, GA, USA. and The Parker H. Petit Institute for Bioengineering and Biosciences, Georgia Institute of Technology, Atlanta, GA, USA and Emory University School of Medicine, Department of Pediatrics, Division of Pediatric Hematology/Oncology, Atlanta, GA, USA and Children's Healthcare of Atlanta, Aflac Cancer & Blood Disorders Center, Atlanta, GA, USA and Institute of Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA, USA
| | - Joscelyn C Mejias
- The Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech and Emory University, Atlanta, GA, USA. and The Parker H. Petit Institute for Bioengineering and Biosciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - Sattva S Neelapu
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Krishnendu Roy
- The Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech and Emory University, Atlanta, GA, USA. and The Parker H. Petit Institute for Bioengineering and Biosciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - Wilbur A Lam
- The Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech and Emory University, Atlanta, GA, USA. and The Parker H. Petit Institute for Bioengineering and Biosciences, Georgia Institute of Technology, Atlanta, GA, USA and Emory University School of Medicine, Department of Pediatrics, Division of Pediatric Hematology/Oncology, Atlanta, GA, USA and Children's Healthcare of Atlanta, Aflac Cancer & Blood Disorders Center, Atlanta, GA, USA and Institute of Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA, USA
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Cabrero M, Martin A, Briones J, Gayoso J, Jarque I, López J, Grande C, Heras I, Arranz R, Bernal T, Perez-Lopez E, López-Godino O, Conde E, Caballero D. Phase II Study of Yttrium-90-Ibritumomab Tiuxetan as Part of Reduced-Intensity Conditioning (with Melphalan, Fludarabine ± Thiotepa) for Allogeneic Transplantation in Relapsed or Refractory Aggressive B Cell Lymphoma: A GELTAMO Trial. Biol Blood Marrow Transplant 2017; 23:53-59. [DOI: 10.1016/j.bbmt.2016.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 10/05/2016] [Indexed: 10/20/2022]
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Dozzo M, Carobolante F, Donisi PM, Scattolin A, Maino E, Sancetta R, Viero P, Bassan R. Burkitt lymphoma in adolescents and young adults: management challenges. Adolesc Health Med Ther 2017; 8:11-29. [PMID: 28096698 PMCID: PMC5207020 DOI: 10.2147/ahmt.s94170] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
About one-half of all Burkitt lymphoma (BL) patients are younger than 40 years, and one-third belong to the adolescent and young adult (AYA) subset, defined by an age between 15 and 25-40 years, based on selection criteria used in different reports. BL is an aggressive B-cell neoplasm displaying highly characteristic clinico-diagnostic features, the biologic hallmark of which is a translocation involving immunoglobulin and c-MYC genes. It presents as sporadic, endemic, or epidemic disease. Endemicity is pathogenetically linked to an imbalance of the immune system which occurs in African children infected by malaria parasites and Epstein-Barr virus, while the epidemic form strictly follows the pattern of infection by HIV. BL shows propensity to extranodal involvement of abdominal organs, bone marrow, and central nervous system, and can cause severe metabolic and renal impairment. Nevertheless, BL is highly responsive to specifically designed short-intensive, rotational multiagent chemotherapy programs, empowered by the anti-CD20 monoclonal antibody rituximab. When carefully applied with appropriate supportive measures, these modern programs achieve a cure rate of approximately 90% in the average AYA patient, irrespective of clinical stage, which is the best result achievable in any aggressive lymphoid malignancy to date. The challenges ahead concern the following: optimization of management in underdeveloped countries, with reduction of diagnostic and referral-for-care intervals, and the applicability of currently curative regimens; the development of lower intensity but equally effective treatments for frail or immunocompromised patients at risk of death by complications; the identification of very high-risk patients through positron-emission tomography and minimal residual disease assays; and the assessment in these and the few refractory/relapsed ones of new monoclonals (ofatumumab, blinatumomab, inotuzumab ozogamicin) and new molecules targeting c-MYC and key proliferative steps of B-cell malignancies.
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Affiliation(s)
- Massimo Dozzo
- Complex Operative Unit of Hematology, Ospedale dell’Angelo
| | | | - Pietro Maria Donisi
- Simple Departmental Operative Unit of Anatomic Pathology, Ospedale Ss. Giovanni e Paolo, Venice, Italy
| | | | - Elena Maino
- Complex Operative Unit of Hematology, Ospedale dell’Angelo
| | | | - Piera Viero
- Complex Operative Unit of Hematology, Ospedale dell’Angelo
| | - Renato Bassan
- Complex Operative Unit of Hematology, Ospedale dell’Angelo
- Correspondence: Renato Bassan, Complex Operative Unit of Hematology, Ospedale dell’Angelo, Via Paccagnella 11, 30174 Mestre-Venice, Italy, Tel +39 41 965 7362, Fax +39 41 965 7361, Email
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Kim MB, Giesler KE, Tahirovic YA, Truax VM, Liotta DC, Wilson LJ. CCR5 receptor antagonists in preclinical to phase II clinical development for treatment of HIV. Expert Opin Investig Drugs 2016; 25:1377-1392. [PMID: 27791451 PMCID: PMC5776690 DOI: 10.1080/13543784.2016.1254615] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The chemokine receptor CCR5 has garnered significant attention in recent years as a target to treat HIV infection largely due to the approval and success of the drug Maraviroc. The side effects and inefficiencies with other first generation agents led to failed clinical trials, prompting the development of newer CCR5 antagonists. Areas covered: This review aims to survey the current status of 'next generation' CCR5 antagonists in the preclinical pipeline with an emphasis on emerging agents for the treatment of HIV infection. These efforts have culminated in the identification of advanced second-generation agents to reach the clinic and the dual CCR5/CCR2 antagonist Cenicriviroc as the most advanced currently in phase II clinical studies. Expert opinion: The clinical success of CCR5 inhibitors for treatment of HIV infection has rested largely on studies of Maraviroc and a second-generation dual CCR5/CCR2 antagonist Cenicriviroc. Although research efforts identified several promising preclinical candidates, these were dropped during early clinical studies. Despite patient access to Maraviroc, there is insufficient enthusiasm surrounding its use as front-line therapy for treatment of HIV. The non-HIV infection related development activities for Maraviroc and Cenicriviroc may help drive future interests.
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Affiliation(s)
- Michelle B Kim
- a Department of Chemistry , Emory University , Atlanta , GA , USA
| | - Kyle E Giesler
- a Department of Chemistry , Emory University , Atlanta , GA , USA
| | | | - Valarie M Truax
- a Department of Chemistry , Emory University , Atlanta , GA , USA
| | - Dennis C Liotta
- a Department of Chemistry , Emory University , Atlanta , GA , USA
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Link CS, Mies F, Scheele J, Kramer M, Schetelig J, Ordemann R, Hänel M, Bornhäuser M, Ehninger G, Kroschinsky F. Long-term follow-up of patients with relapsed or refractory non-Hodgkin's lymphoma receiving allogeneic stem cell transplantation. Bone Marrow Transplant 2016; 51:1527-1529. [PMID: 27295271 DOI: 10.1038/bmt.2016.165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- C S Link
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - F Mies
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany.,Klinik für Innere Medizin III, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - J Scheele
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - M Kramer
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - J Schetelig
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - R Ordemann
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - M Hänel
- Klinik für Innere Medizin III, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - M Bornhäuser
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - G Ehninger
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - F Kroschinsky
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
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40
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Yun S, Vincelette ND, Abraham I, Puvvada S, Anwer F. Outcome Comparison of Allogeneic versus Autologous Stem Cell Transplantation in Transformed Low-Grade Lymphoid Malignancies: A Systematic Review and Pooled Analysis of Comparative Studies. Acta Haematol 2016; 136:244-255. [PMID: 27802434 DOI: 10.1159/000449031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 08/09/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Some patients with low-grade lymphoid malignancies develop transformed disease, requiring stem cell transplantation (SCT). SCT outcomes in transformed low-grade lymphoid malignancies may differ from those of nontransformed disease or other aggressive non-Hodgkin lymphomas. We conducted a pooled analysis of the clinical outcomes of allogeneic versus high-dose therapy (HDT) with autologous SCT in adult patients with transformed low-grade lymphoid malignancies. METHODS A PubMed, EMBASE, and Cochrane search yielded 4 comparative studies reporting allogeneic versus HDT with autologous SCT outcomes in adults (age ≥18) with transformed low-grade lymphoid malignancies, including follicular, chronic/small lymphocytic, and marginal zone lymphoma. Risk ratio (RR) and 95% CI were calculated using random-effects models. RESULTS Rates for overall survival (OS) were 51.0 versus 69.5% (RR = 1.55, 95% CI 1.19-2.02, p = 0.001), rates of relapse were 37.3 versus 35.3% (RR = 1.04, 95% CI 0.70-1.55, p = 0.84), and rates of transplant-related mortality (TRM) were 33.3 versus 7.2% (RR = 4.52, 95% CI 2.75-7.43, p < 0.00001) for allogeneic versus autologous SCT. Previous rituximab treatment, reduced intensity conditioning regimen prior to SCT, or original pathology had no prognostic impact. CONCLUSION HDT followed by autologous SCT was associated with lower TRM and a better OS, but there was no difference in relapse versus allogeneic SCT. Autologous SCT may be the better therapeutic option, considering the second chance of allogeneic SCT in the case of relapse.
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Affiliation(s)
- Seongseok Yun
- Department of Hematology and Oncology, H. Lee Moffitt Cancer Center, Tampa, Fla., USA
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Capria S, Barberi W, Perrone S, Ferretti A, Salaroli A, Annechini G, D'Elia GM, Foà R, Pulsoni A. Reappraising the timing of transplant for indolent non-Hodgkin lymphomas. Expert Rev Hematol 2016; 9:951-64. [PMID: 27539362 DOI: 10.1080/17474086.2016.1226128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Indolent non-Hodgkin lymphomas (iNHL) remain incurable with standard approaches. The timing of autologous stem cell transplant (ASCT) is changing following the introduction of new drugs that can potentially defer the transplant, improved reduced intensity conditioning (RIC) and haploidentical allogeneic SCT (allo-SCT). AREAS COVERED The most relevant aspects concerning the role of hematopoietic stem cell transplantation in the management of iNHL are discussed. Literature search methodology included examination of PubMed index and meeting presentations. Expert commentary: ASCT is not currently employed as consolidation in first-line, being reserved to patients with refractory/relapsed disease. The curative potential of graft-versus-lymphoma (GVL) after RIC allo-SCT could be particularly beneficial in patients with iNHL relapsing after ASCT. This scenario could be modified in the near future by better definition of high-risk patients at diagnosis, by the improvement of minimal residual disease (MRD) evaluation and by the introduction of new drugs in the therapeutic algorithm.
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Affiliation(s)
- Saveria Capria
- a Hematology, Department of Cellular Biotechnologies and Hematology , Sapienza University , Rome , Italy
| | - Walter Barberi
- a Hematology, Department of Cellular Biotechnologies and Hematology , Sapienza University , Rome , Italy
| | - Salvatore Perrone
- a Hematology, Department of Cellular Biotechnologies and Hematology , Sapienza University , Rome , Italy
| | - Antonietta Ferretti
- a Hematology, Department of Cellular Biotechnologies and Hematology , Sapienza University , Rome , Italy
| | - Adriano Salaroli
- a Hematology, Department of Cellular Biotechnologies and Hematology , Sapienza University , Rome , Italy
| | - Giorgia Annechini
- a Hematology, Department of Cellular Biotechnologies and Hematology , Sapienza University , Rome , Italy
| | - Gianna Maria D'Elia
- a Hematology, Department of Cellular Biotechnologies and Hematology , Sapienza University , Rome , Italy
| | - Robin Foà
- a Hematology, Department of Cellular Biotechnologies and Hematology , Sapienza University , Rome , Italy
| | - Alessandro Pulsoni
- a Hematology, Department of Cellular Biotechnologies and Hematology , Sapienza University , Rome , Italy
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Ghosh N, Karmali R, Rocha V, Ahn KW, DiGilio A, Hari PN, Bachanova V, Bacher U, Dahi P, de Lima M, D'Souza A, Fenske TS, Ganguly S, Kharfan-Dabaja MA, Prestidge TD, Savani BN, Smith SM, Sureda AM, Waller EK, Jaglowski S, Herrera AF, Armand P, Salit RB, Wagner-Johnston ND, Fuchs E, Bolaños-Meade J, Hamadani M. Reduced-Intensity Transplantation for Lymphomas Using Haploidentical Related Donors Versus HLA-Matched Sibling Donors: A Center for International Blood and Marrow Transplant Research Analysis. J Clin Oncol 2016; 34:3141-9. [PMID: 27269951 DOI: 10.1200/jco.2015.66.3476] [Citation(s) in RCA: 189] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
PURPOSE Related donor haploidentical hematopoietic cell transplantation (Haplo-HCT) using post-transplantation cyclophosphamide (PT-Cy) is increasingly used in patients lacking HLA-matched sibling donors (MSD). We compared outcomes after Haplo-HCT using PT-Cy with MSD-HCT in patients with lymphoma, using the Center for International Blood and Marrow Transplant Research registry. MATERIALS AND METHODS We evaluated 987 adult patients undergoing either Haplo-HCT (n = 180) or MSD-HCT (n = 807) following reduced-intensity conditioning regimens. The haploidentical group received graft-versus-host disease (GVHD) prophylaxis with PT-Cy with or without a calcineurin inhibitor and mycophenolate. The MSD group received calcineurin inhibitor-based GVHD prophylaxis. RESULTS Median follow-up of survivors was 3 years. The 28-day neutrophil recovery was similar in the two groups (95% v 97%; P = .31). The 28-day platelet recovery was delayed in the haploidentical group compared with the MSD group (63% v 91%; P = .001). Cumulative incidence of grade II to IV acute GVHD at day 100 was similar between the two groups (27% v 25%; P = .84). Cumulative incidence of chronic GVHD at 1 year was significantly lower after Haplo-HCT (12% v 45%; P < .001), and this benefit was confirmed on multivariate analysis (relative risk, 0.21; 95% CI, 0.14 to 0.31; P < .001). For Haplo-HCT v MSD-HCT, 3-year rates of nonrelapse mortality (15% v 13%; P = .41), relapse/progression (37% v 40%; P = .51), progression-free survival (48% v 48%; P = .96), and overall survival (61% v 62%; P = .82) were similar. Multivariate analysis showed no significant difference between Haplo-HCT and MSD-HCT in terms of nonrelapse mortality (P = .06), progression/relapse (P = .10), progression-free survival (P = .83), and overall survival (P = .34). CONCLUSION Haplo-HCT with PT-Cy provides survival outcomes comparable to MSD-HCT, with a significantly lower risk of chronic GVHD.
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Affiliation(s)
- Nilanjan Ghosh
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Reem Karmali
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Vanderson Rocha
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Kwang Woo Ahn
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Alyssa DiGilio
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Parameswaran N Hari
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Veronika Bachanova
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Ulrike Bacher
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Parastoo Dahi
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Marcos de Lima
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Anita D'Souza
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Timothy S Fenske
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Siddhartha Ganguly
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Mohamed A Kharfan-Dabaja
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Tim D Prestidge
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Bipin N Savani
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Sonali M Smith
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Anna M Sureda
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Edmund K Waller
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Samantha Jaglowski
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Alex F Herrera
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Philippe Armand
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Rachel B Salit
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Nina D Wagner-Johnston
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Ephraim Fuchs
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Javier Bolaños-Meade
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Mehdi Hamadani
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD.
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Robinson SP, Boumendil A, Finel H, Schouten H, Ehninger G, Maertens J, Crawley C, Rambaldi A, Russell N, Anders W, Blaise D, Yakoub-Agha I, Ganser A, Castagna L, Volin L, Cahn JY, Montoto S, Dreger P. Reduced intensity allogeneic stem cell transplantation for follicular lymphoma relapsing after an autologous transplant achieves durable long-term disease control: an analysis from the Lymphoma Working Party of the EBMT†. Ann Oncol 2016; 27:1088-1094. [PMID: 26961149 DOI: 10.1093/annonc/mdw124] [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: 11/29/2015] [Revised: 02/17/2016] [Accepted: 02/22/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients with follicular lymphoma (FL) relapsing after an autologous transplant (autoSCT) may be treated with a variety of therapies, including a reduced intensity allogeneic transplant (RICalloSCT). We conducted a retrospective analysis of a large cohort of patients undergoing RICalloSCT for FL in this setting. PATIENTS AND METHODS A total of 183 patients, median age 45 years (range 21-69), had undergone an autoSCT at a median of 30 months before the RICalloSCT. Before the RICalloSCT, they had received a median of four lines (range 3-10) of therapy and 81% of patients had chemosensitive disease and 16% had chemoresistant disease. Grafts were donated from sibling (47%) or unrelated donors (53%). RESULTS With a median follow-up of 59 months, the non-relapse mortality (NRM) was 27% at 2 years. The median remission duration post-autoSCT and RICalloSCT was 14 and 43 months, respectively. The 5-year relapse/progression rate, progression-free survival and overall survival were 16%, 48% and 51%, respectively, and were associated with age and disease status at RICalloSCT. CONCLUSION These data suggest that an RICalloSCT is an effective salvage strategy in patients with FL recurring after a prior autoSCT and might overcome the poor prognostic impact of early relapse after autoSCT.
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Affiliation(s)
- S P Robinson
- BMT Unit, University Hospital Bristol NHS Foundation Trust, Bristol, UK; Lymphoma Working Party EBMT, Paris, France.
| | | | - H Finel
- Lymphoma Working Party EBMT, Paris, France
| | - H Schouten
- Department of Haematology, University Hospital, Maastricht, The Netherlands
| | - G Ehninger
- Department of Haematology, Universitaetsklinikum, Dresden, Germany
| | - J Maertens
- Department of Haematology, University Hospital Gasthuisberg, Leuven, Belgium
| | - C Crawley
- Department of Haematology, Addenbrookes Hospital, Cambridge, UK
| | - A Rambaldi
- Haematology and Bone Marrow Transplant Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - N Russell
- Department of Haematology, City Hospital, Nottingham, UK
| | - W Anders
- Department of Haematology, University Hospital, Umea, Sweden
| | - D Blaise
- Department of Haematology, Institut Paoli Calmettes, Marseille
| | - I Yakoub-Agha
- Department of Haematology, Hôpital Claude Huriez, Lille, France
| | - A Ganser
- Department of Haematology, Medical School, Hannover, Germany
| | - L Castagna
- Department of Haematology, Istituto Clinico Humanitas, Milano, Italy
| | - L Volin
- HUH Comprehensive Cancer Center, Stem Cell Transplantation Unit, Helsinki, Finland
| | - J-Y Cahn
- Haematology, Clinique Universitaire d'Hématologie CHU Grenoble UMR 38043, Grenoble Cedex 09, France
| | - S Montoto
- Lymphoma Working Party EBMT, Paris, France; Department of Haematology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - P Dreger
- Lymphoma Working Party EBMT, Paris, France; Department of Medicine V, University of Heidelberg, Heidelberg, Germany
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Fonseca-Hial AMR, Parisio K, Oliveira JSR. Allogeneic hematopoietic stem cell transplantation in patients with advanced indolent lymphoproliferative disorders. Rev Bras Hematol Hemoter 2016; 38:99-105. [PMID: 27208567 PMCID: PMC4877659 DOI: 10.1016/j.bjhh.2016.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 02/22/2016] [Accepted: 02/24/2016] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The role of allogeneic hematopoietic stem cell transplantation for advanced indolent lymphoproliferative disorders remains to be established. OBJECTIVE This paper aims to describe the results of allogeneic hematopoietic stem cell transplantation in patients with advanced indolent lymphoproliferative disorders. METHODS This article reports on 29 adult patients submitted to allogeneic transplantations from 1997 to 2010. RESULTS Most had follicular non-Hodgkin lymphoma (n=14) or chronic lymphocytic leukemia (n=12). The median age was 44 years (range: 24-53 years) and 65% of patients were male. Only 21% had had access to rituximab and 45% to fludarabine. All had advanced disease (stage IV) with partial response or stable disease. Most underwent myeloablative conditioning n=17-59%). In this scenario, refractory disease was observed in seven (24%) patients, the 100-day mortality rate was 17% (n=5) and relapse occurred in four patients (18%). The main cause of death throughout the follow up was refractory disease in six of the 12 patients who died. Moderate and severe chronic graft-versus-host disease was frequent; about 41% of 24 patients analyzed. The overall survival rates and disease free survival at 42 months were 56.7% and 45.4%, respectively. According to Kaplan-Meyer analysis, the median time from diagnosis to transplant predicted the overall survival; however age, gender and conditioning regimen did not predict the prognosis. It was impossible to reach other conclusions because of the small sample size in this study. CONCLUSIONS The role of allogeneic transplantations should be re-evaluated in the era of targeted therapy.
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Affiliation(s)
- Ana Marcela Rojas Fonseca-Hial
- Hospital São Paulo, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil; Hospital Santa Marcelina, São Paulo, SP, Brazil.
| | | | - Jose Salvador Rodrigues Oliveira
- Hospital São Paulo, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil; Hospital Santa Marcelina, São Paulo, SP, Brazil
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Laport GG, Wu J, Logan B, Bachanova V, Hosing C, Fenske T, Longo W, Devine SM, Nademanee A, Gersten I, Horowitz M, Lazarus HM, Riches ML. Reduced-Intensity Conditioning with Fludarabine, Cyclophosphamide, and High-Dose Rituximab for Allogeneic Hematopoietic Cell Transplantation for Follicular Lymphoma: A Phase Two Multicenter Trial from the Blood and Marrow Transplant Clinical Trials Network. Biol Blood Marrow Transplant 2016; 22:1440-1448. [PMID: 27118571 DOI: 10.1016/j.bbmt.2016.04.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 04/18/2016] [Indexed: 10/21/2022]
Abstract
Allogeneic (allo) hematopoietic cell transplantation (HCT) can induce long-term remissions in chemosensitive relapsed follicular lymphoma (FL). The Blood and Marrow Transplant Clinical Trials Network conducted a multicenter phase 2 trial to examine the efficacy of alloHCT using reduced-intensity conditioning with rituximab (RTX) in multiply relapsed, chemosensitive FL. The primary endpoint was 2-year progression-free survival (PFS). The conditioning regimen consisted of fludarabine, cyclophosphamide, and high-dose RTX (FCR), in which 3 of the 4 doses of RTX were administered at a dose of 1 gm/m(2). Graft-versus-host disease (GVHD) prophylaxis was with tacrolimus and methotrexate. Sixty-five patients were enrolled and 62 were evaluable. Median age was 55 years (range, 29 to 74). This group was heavily pretreated: 77% had received ≥ 3 prior regimens, 32% had received ≥ 5 prior regimens, and 11% had received prior autologous HCT. Donors were HLA-matched siblings (n = 33) or HLA-matched unrelated adults (n = 29). No graft failures occurred. The overall response rate after HCT was 94% with 90% in complete remission (CR), including 24 patients not in CR before alloHCT. With a median follow-up of 47 months (range, 30 to 73), 3-year PFS and overall survival rates were 71% (95% confidence interval, 58% to 81%) and 82% (95% confidence interval, 70% to 90%), respectively. Three-year cumulative incidences of relapse/progression and nonrelapse mortality were 13% and 16%, respectively. Two-year cumulative incidences of grades 2 to 4 and grades 3 or 4 acute GVHD were 27% and 10%, respectively, and extensive chronic GVHD incidence was 55%. Serum RTX concentrations peaked at day +28 and remained detectable as late as 1 year in 59% of patients with available data. In conclusion, alloHCT with FCR conditioning confers high CR rates, a low incidence of relapse/progression, and excellent survival probabilities in heavily pretreated FL patients.
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Affiliation(s)
- Ginna G Laport
- Stanford University Medical Center, Stanford, California
| | - Juan Wu
- The EMMES Corporation, Rockville, Maryland
| | - Brent Logan
- Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Chitra Hosing
- University of Texas/MD Anderson Cancer Center, Houston, Texas
| | | | | | | | | | | | | | | | - Marcie L Riches
- Division of Hematology/Oncology, University of North Carolina, Chapel Hill, North Carolina.
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Treatment of CD20-directed Chimeric Antigen Receptor-modified T cells in patients with relapsed or refractory B-cell non-Hodgkin lymphoma: an early phase IIa trial report. Signal Transduct Target Ther 2016; 1:16002. [PMID: 29263894 PMCID: PMC5661644 DOI: 10.1038/sigtrans.2016.2] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 01/11/2016] [Accepted: 01/14/2016] [Indexed: 11/08/2022] Open
Abstract
Patients with relapsed or refractory non-Hodgkin lymphoma have a dismal prognosis. Chimeric Antigen Receptor (CAR)-modified T cells (CART cells) that targeted CD20 were effective in a phase I clinical trial for patients with advanced B-cell lymphomas. We performed a phase IIa trial to further assess the safety and efficacy of administering autologous anti-CD20 CART (CART-20) cells to patients with refractory or relapsed CD20+ B-cell lymphoma. Eleven patients were enrolled, and seven patients underwent cytoreductive chemotherapy to debulk the tumors and deplete the lymphocytes before receiving T-cell infusions. The overall objective response rate was 9 of 11 (81.8%), with 6 complete remissions (CRs) and 3 partial remissions; no severe toxicity was observed. The median progression-free survival lasted for >6 months, and 1 patient had a 27-month continuous CR. A significant inverse correlation between the levels of the CAR gene and disease recurrence or progression was observed. Clinically, the lesions in special sites, specifically the spleen and testicle, were refractory to CART-20 treatment. Collectively, these results together with our data from phase I strongly demonstrated the feasibility and efficacy of CART-20 treatment in lymphomas and suggest large-scale patient recruitment in a future study. This study was registered at www.clinicaltrials.org as NCT01735604.
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Allogeneic hematopoietic cell transplantation as curative therapy for non-transformed follicular lymphomas. Bone Marrow Transplant 2016; 51:654-62. [PMID: 26855152 DOI: 10.1038/bmt.2015.348] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 12/03/2015] [Accepted: 12/05/2015] [Indexed: 01/16/2023]
Abstract
Allogeneic hematopoietic cell transplantation (HCT) offers the chance of cure for patients with non-transformed follicular lymphoma (FL), but is associated with the risk of non-relapse mortality (NRM). The aim of this study was to identify subgroups of FL patients who benefit from HCT. The European Society for Blood and Marrow Transplantation (EBMT) Minimum-Essential-A Data of 146 consecutive patients who received HCT for FL between 1998 and 2008 were extracted from the database of the German Registry 'DRST'. Diagnosis of FL was verified by contact with the reference pathologists. Estimated 1-, 2- and 5-year overall survivals (OS) were 67%, 60% and 53%, respectively. Day 100 NRM was 15%. Thirteen out of 33 patients (40%) with treatment-refractory disease (RD) at the time of transplantation survived long term. Univariate statistical analysis suggested limited chronic GvHD, donor age ⩽42 years and TBI-based conditioning in treatment refractory patients to correlate with favorable OS. Independent prognostic factors for OS were treatment-sensitive disease and limited chronic GvHD for the whole cohort, and additionally TBI-based conditioning for the treatment refractory subgroup. In contrast, patient age ⩾55 years had no impact on outcome. Thus, HCT for FL is associated with acceptable NRM, and offers a substantial chance of cure for patients with RD or advanced age. Donors ⩽42 years should be preferred if available.
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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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Autologous stem cell transplantation for relapsed/refractory diffuse large B-cell lymphoma: efficacy in the rituximab era and comparison to first allogeneic transplants. A report from the EBMT Lymphoma Working Party. Bone Marrow Transplant 2015; 51:365-71. [PMID: 26618550 DOI: 10.1038/bmt.2015.286] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 09/06/2015] [Accepted: 09/19/2015] [Indexed: 12/22/2022]
Abstract
In the era of chemoimmunotherapy, the optimal treatment paradigm for relapsed and refractory diffuse large B-cell lymphoma has been challenged. We reviewed the outcome of standard salvage therapy with an autologous stem cell transplant (autoSCT) over the last two decades and the outcome of allogeneic SCT (alloSCT) in the most recent decade. AutoSCT recipients diagnosed between 1992 and 2002 (n=2737) were compared with those diagnosed between 2002 and 2010 (n=3980). Patients diagnosed after 2002 had a significantly lower non-relapse mortality (NRM) and relapse incidence (RI) and a superior PFS and overall survival (OS). A total of 4210 patients diagnosed between 2002 and 2010 underwent either an autoSCT or an alloSCT as their first transplant procedure. Two-hundred and thirty patients received an alloSCT (myeloablative (MACalloSCT) n=132, reduced intensity (RICalloSCT) n=98). The 4-year NRM rates were 7%, 20% and 27% for autoSCT, RICalloSCT and MACalloSCT, respectively. The 4-year RI was 45%, 40% and 38% for autoSCT, RICalloSCT and MACalloSCT, respectively (NS). The 4-year PFS were 48%, 52% and 35% for autoSCT, RICalloSCT and MACalloSCT, respectively. The 4-year OS was 60%, 52% and 38% for autoSCT, RIC alloSCT and MACalloSCT, respectively. After adjustment for confounding factors NRM was significantly worse for patients undergoing alloSCT whilst there was no difference in the RI.
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