Fludarabine-melphalan-campath, followed by unmanipulated peripheral-blood haematopoietic stem cells, can still cure lymphoma
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Authors
Avenoso, Daniele
Alabdulwahab, Amal
Kenyon, Michelle
Mehra, Varun
Krishnamurthy, Pramila
Dazzi, Francesco
Leung, Ye Ting
Anteh, Sandra
Shah, Mili Naresh
Kuhnl, Andrea
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Issue Date
2023
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Article
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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- 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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Mediterranean Journal of Hematology and Infectious Diseases
Volume
15
Issue
1