Reduced Intensity conditioning followed by allo-HSCT in patients with refractory/relapsing lymphomas
PO-1171
Abstract
Reduced Intensity conditioning followed by allo-HSCT in patients with refractory/relapsing lymphomas
Authors: Simonetta Saldi1, Federico Camilli2, Andrea Guerini3, Alessandra Carotti4, Antonio Pierini5, Vittorio Bini6, Stefano Magrini3, Michela Buglione3, Cynthia Aristei7
1Santa Maria della Misericordia Hospital, Department of Radiation Oncology, Perugia, Italy; 2University of Perugia, Department of Radiation Oncology, Perugia, Italy; 3University of Brescia and Spedali Civili Hospital, Department of Radiation Oncology, Istituto del Radio O. Alberti, Brescia, Italy; 4Santa Maria della Misericordia Hospital, Department of Haematology, Perugia, Italy; 5Santa Maria della Misericordia Hospital and University of Perugia, Department of Haematology, Perugia, Italy; 6University of Perugia and Santa Maria della Misericordia Hospital, Department of Medicine, Section of Internal Medicine, Endocrinology & Metabolism, Perugia, Italy; 7University of Perugia and Santa Maria della Misericordia Hospital, Department of Radiation Oncology, Perugia, Italy
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Purpose or Objective
Since standard high-dose chemotherapy followed by autologous haematopoietic stem cell transplantation (HSCT) often fails in patients with lymphomas, allogeneic HSCT (allo-HSCT) with reduced intensity conditioning (RIC) has emerged as a feasible salvage strategy. It administer fludarabine, cyclophosphamide and low-dose total body irradiation (TBI) and exerts its action through an immunosuppressive effects RIC was reported to lower transplant-related mortality in most series of patients and improve survival in some. With the aim of evaluating outcomes after RIC and allo-HSCT we designed a multi-centre retrospective observational study enrolling patients with refractory or relapsed lymphomas.
Material and Methods
The study recruited 36 patients, 32 of whom had failed high-dose autologous HSCT (19 male, 17 female; median age 45 years;(range 7-79); mean KPS 90% (range: 70-100)). Patients were affected by Hodgkin’s lymphoma (16), T cell lymphoma (9), diffuse B cells large lymphoma (7), mantle cell lymphoma (2) and follicular lymphoma (2). Patients received fludarabine from days −6 to −2, cyclophosphamide on days -5 and -6 and 2-4 Gy total body irradiation on day -1. Allo-HSCT were HLA-matched related (16) or unrelated (20). Post-transplant immunosuppression consisted of cyclophosphamide, tacrolimus and mycophenolate mofetil in 20 unrelated allo-HSCT recipients and cyclophosphamide and cyclosporine for 16 matched allo-HSCT recipients.
Results
Stable engraftment was achieved in 32/36 patients; 4 patients had non fatal rejections. Good response was elicited in 23/32 patients (63.9%). Disease progression was observed in 9. The acute toxicity rate was 19.5.% (5 gastrointestinal, 1 renal, 1 veno-occlusive disease ( VOD) ). Post-transplant infections developed in 12/36 patients (33.3%). Acute graft-versus-host disease (GvHD) was found in 9/36 patients (25%).It was Grade I in 3 (8.3%), Grade II in 4 ( 11.1%), Grade III in 2 (5.6%) . Six patients (16.7%) developed chronic GVHD (Grade I in 5 patients (13.9%) Grade II in 1 (2.8%). At 60 months post-transplant 7 patients (19.4%) died, 2 of relapse (5.6%) and 5 (13.9) of non-relapse mortality, one of them trasplantation related mortality. The 5-year Kaplan-Meier probabilities of overall and disease-free survivals were 78.1% and 93.4%, respectively.
Conclusion
Allo-HSCT after RIC is a promising salvage strategy for patients with relapsed and refractory lymphoma. The high response and low relapse rates suggest that lymphoma cells are susceptible to graft-vs-tumor responses.