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EBMT 2019 | Tandem autologous-reduced-intensity allogeneic SCT for R/R HL

Mar 27, 2019

On Tuesday 26 March 2019, Oral Session 4 (OS4)took place at the 45 thAnnual Meeting of the European Society of Blood and Marrow Transplantation (EBMT), Frankfurt, DE. During that session, Abstract OS4-1 was presented by Leyre Bentofrom Son Espases University Hospital, Palma de Mallorca, SP.

This presentation provided results of a retrospective study from the Lymphoma Working Party (LWP) and EBMT, regarding the efficacy and safety of tandem autologous-reduced intensity allogeneic stem cell transplantation (auto-RIC allo-SCT) in high-risk relapsed or refractory (R/R) Hodgkin lymphoma (HL). The primary endpoint of the study was progression-free survival (PFS) after auto-RIC-allo-SCT. Secondary endpoints included overall survival (OS), cumulative incidence of non-relapse mortality (NRM), incidence of relapse (IR) and graft-versus-host disease (GvHD).

Study design & baseline characteristics

  • N = 130 patients with R/R HL from the EBMT registry treated with auto-RIC
  • Median age at auto-SCT (range): 30 (18−65) years
  • Males: 58%
  • Median time between diagnosis and auto-SCT (range): 16 (2−174) months
  • Median number of prior lines before auto-SCT (range): 2 (2−4)
    • Patients with ≥ 3 prior lines: 33% (n = 43)
  • Patient disease status at auto-SCT:
    • Complete response (CR): 32% (n = 41)
    • Partial response (PR): 27% (n = 35)
    • Active disease: 41% (n = 54)
  • RIC-SCT characteristics:
    • Donor type:
      • Identical sibling: 40%
      • Unrelated: 39%
      • Haplo: 21%
    • Conditioning:
      • Fludarabine (Flu) ± cyclophosphamide (Cy) ± busulfan: 38%
      • Flu + melphalan: 8%
      • Flu ± busulfan + thymoglobulin: 32%
      • Other: 21%
    • GvHD prophylaxis:
      • Cyclosporine & methotrexate: 36%
      • Cyclosporine & micofenolate mofetil: 16%
      • Post-transplant Cy: 17%
      • Other: 31%

Key results

  • Three-year cumulative IR: 34% (95% CI, 25−43%)
  • Three-year NRM: 13% (95% CI, 8−20%)
  • Three-year PFS: 53% (95% CI, 44−63%)
  • Three-year OS: 72% (95% CI, 64−80%)
  • After a median follow-up of 44 months (range, 6−130):
    • Patients who relapsed: 33%
    • Patients who died: 34%
      • Death due to SCT-related causes: 53%
      • Death due to disease: 35%
      • Other causes: 12%
  • Cumulative incidence of Grade III−IV acute GvHD at Day 100 after RIC-SCT: 10% (5−16%)
  • Three-year cumulative incidence of chronic GvHD after RIC-SCT: 26% (18−36%)
  • Univariate analysis revealed the following factors affecting PFS and IR:

  Outcome

Variable

Decreased PFS

 

Female patient

Not in CR at auto-/allo-SCT

Increased cumulative IR

Female patient

Not in CR at auto-/allo-SCT

Decreased engraftment

Total body irradiation (TBI) before allo-SCT

Cord blood

Increased acute GvHD

Unrelated donors

Increased chronic GvHD

Thymoglobulin-based conditioning

Female donor

  • Three-year PFS according to time from diagnosis to auto-SCT:
    • ≤ 12 months: 49%
    • > 12 months: 54%
  • Three-year OS according to time from diagnosis to auto-SCT:
    • ≤ 12 months: 69%
    • > 12 months: 72%
  • Three-year PFS according to number of prior lines:
    • < 3 lines: 57%
    • ≥ 3 lines: 45%
  • Three-year OS according to number of prior lines:
    • < 3 lines: 77%
    • ≥ 3 lines: 62%

Conclusions

  • The low NRM and cumulative RI along with the promising PFS and OS rates suggest that auto-RIC-SCT might be an effective approach in R/R NHL
  • Approximately 50% of patients with a time from diagnosis to auto-SCT ≤ 12 months or ≥ 3 prior lines before auto-SCT (high-risk population) remained disease free at three years
  1. Bento L. et al. Tandem autologous-reduced intensity allogeneic stem cell transplantation in relapsed Hodgkin lymphoma: A retrospective study of the LWP-EBMT. Abstract OS4-1: 45th EBMT Annual Meeting , Frankfurt, Germany