Autologous Transplant in Gray Zone Lymphoma

Mohammed Kharfan-Dabaja of the Moffitt Cancer Center in Tampa, Florida, and colleagues investigated outcomes in Gray Zone Lymphoma (GZL) patients after autologous stem cell transplant. The findings were published online December 7, 2017, in the journal Biology of Blood and Marrow Transplantation. 

Gray Zone Lymphoma has features which are intermediate between Diffuse Large B-Cell Lymphoma and classical Hodgkin’s Lymphoma.  GZL is very rare, and there is no standard treatment recommendation for this diagnosis. The goal of this study was to review therapy outcomes for relapsed or refractory GZL after autologous stem cell transplant (SCT).

Patient Population

• N = 32 patients
• Median age = 38 years
• Prep regimens
  • BEAM (carmustine, etoposide, cytarabine, melphalan) = 59%
  • BEAM-R (BEAM + rituximab) = 13%
  • Other regimens = 28%
• Number of therapies prior to SCT
  • One = 25%
  • More than one = 75%
• Median stem cell dose = 4.93 x 10⁶ cells/kg

 Key Findings

•  Median time to neutrophil and platelet engraftment = 11 days
• Response after 1 year
  • Complete remission (CR) = 57.1%
  • Partial remission (PR) = 28.5%
  • Relapse = 9.5%
• Three-year overall survival (OS) = 78% (95% CI, 61%–95%)
  • Patients in CR or not in CR had no difference in 3-year OS
  • Number of prior therapies made no difference in 3-year OS
• Three-year progression-free survival (PFS) = 69% (95% CI, 49%–88%)
  • Patients in CR or not in CR had no difference in 3-year PFS
  • Number of prior therapies made no difference in 3-year PFS
• Three-year relapse/progression = 31% (95% CI, 17%–59%)
• Three-year non-relapse mortality (NRM) = 0 patients

These findings suggest that autologous transplant may be a suitable treatment option for Gray Zone Lymphoma. The results of this observation should be validated in a larger, prospective study, to confirm outcomes of autologous transplant in this population.