Fludarabine-melphalan as a preparative regimen for reduced-intensity conditioning allogeneic stem cell transplantation in relapsed and refractory Hodgkin's lymphoma: The updated M.D. Anderson Cancer Center experience

Paolo Anderlini*, Rima Saliba, Sandra Acholonu, Sergio A. Giralt, Borje Andersson, Naoto T. Ueno, Chitra Hosing, Issa F. Khouri, Daniel Couriel, Marcos De Lima, Muzaffar H. Qazilbash, Barbara Pro, Jorge Romaguera, Luis Fayad, Frederick Hagemeister, Anas Younes, Mark F. Munsell, Richard E. Champlin

*Corresponding author for this work

Research output: Contribution to journalArticle

115 Scopus citations

Abstract

Background: The role of reduced-intensity conditioning allogeneic stem cell transplantation in relapsed/refractory Hodgkin's lymphoma remains poorly defined. We here present an update of our single-center experience with fludarabine-melphalan as a preparative regimen. Design and Methods: Fifty-eight patients with relapsed/refractory Hodgkin's lymphoma underwent RIC and allogeneic stem cell transplantation from a matched related donor (MRD; n=25) or a matched unrelated donor (MUD; n=33). Forty-eight (83%) had undergone prior autologous stem cell transplantation. Disease status at transplant was refractory relapse (n=28) or sensitive relapse (n=30). Results: Cumulative day 100 and 2-year transplant-related mortality rates were 7% and 15%, respectively (day 100 transplant-related mortality MRD vs. MUD 8% vs. 6%, p=ns; 2-year MRD vs. MUD 13% vs. 16%, p=ns). The cumulative incidence of acute (grade II-IV) graft-versus-host disease in the first 100 days was 28% (MRD vs. MUD 12% vs. 39%, p=0.04). The cumulative incidence of chronic graft-versus-host disease at any time was 73% (MRD vs. MUD 57% vs. 85%, p=0.006). Projected 2-year overall and progression-free survival rates are 64% (49-76%) and 32% (20-45%), with 2-year disease progression/relapse at 55% (43-70%). There was no statistically significant differences in overall survival progression-free survival, and disease progression/relapse between MRD and MUD transplants. There was a trend for the response status pretransplant to have a favorable impact on progression-free survival (p=0.07) and disease progression/relapse (p=0.049), but not on overall survival (p=0.4) Conclusions: Fludarabine-melphalan as a preparative regimen for reduced-intensity conditioning allogeneic stem cell transplantation in progression-free survival Hodgkin's lymphoma is associated with a significant reduction in transplant-related mortality, with comparable results in MRD and MUD allografts. Optimizing pretransplant response status may improve patients' outcome.

Original languageEnglish (US)
Pages (from-to)257-264
Number of pages8
JournalHaematologica
Volume93
Issue number2
DOIs
StatePublished - Feb 2008

Keywords

  • Hodgkin's lymphoma
  • Stem cell transplantation

ASJC Scopus subject areas

  • Hematology

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    Anderlini, P., Saliba, R., Acholonu, S., Giralt, S. A., Andersson, B., Ueno, N. T., Hosing, C., Khouri, I. F., Couriel, D., De Lima, M., Qazilbash, M. H., Pro, B., Romaguera, J., Fayad, L., Hagemeister, F., Younes, A., Munsell, M. F., & Champlin, R. E. (2008). Fludarabine-melphalan as a preparative regimen for reduced-intensity conditioning allogeneic stem cell transplantation in relapsed and refractory Hodgkin's lymphoma: The updated M.D. Anderson Cancer Center experience. Haematologica, 93(2), 257-264. https://doi.org/10.3324/haematol.11828