ISHL10 Abstract P097

Long-term outcome of reduced-intensity allogeneic transplant in relapsed/refractory Hodgkin’s lymphoma: the timing of relapse after autologous transplant and primary refractory disease do not impact the long-term survival

This study analyzed a cohort of consecutive patients with relapsed/refractory Hodgkin’s lymphoma (RR-HL) receiving reduced intensity allogeneic transplant (alloSCT) in a single center to understand whether the timing of relapse after autologous transplant (ASCT) or primary refractory disease would change the survival after allograft. Of 243 patients with HL referred to our division from 2001 to 2014, 105 had RR-HL (64 primary refractory). After salvage treatment, 62 patients (59%) underwent alloSCT with thiotepa-based conditioning, 43 patients did not receive alloSCT due to progressive disease (31), age >65 years (3) or complete remission after third line chemotherapy and ASCT (9 patients). Multivariate analysis of alloSCT outcomes included disease pre-transplant status (CR vs PR vs resistant [SD or PD]), donor type (HLA identical, matched unrelated [MUD], or T-depleted or T-repleted haploidentical), primary refractory disease (yes vs no) and timing of relapse after ASCT (<12 months after ASCT vs >12 months vs no ASCT). Allografted patients had a median of 33 years, 76% had a primary refractory disease, 25% had persistent disease at alloSCT. Donors were HLA identical siblings (42%), MUD (29%) or haploidentical (29%); 74% of patients relapsed <12 months, 15% relapsed >12 months after ASCT, and 11% had not received ASCT. After a median follow-up of 5.4 years, 5-year OS was 59% (CI95% 47-71%), PFS and relapse incidence were 46% (CI95% 34-58%) and 38% (CI95% 26-50%). Non-relapse mortality (NRM) was 10% at 100 days (CI95% 3-17%), 17% at 1 year (CI95% 8-26%) and subsequently for the entire follow-up. In multivariate analysis, the timing of relapse after ASCT and primary refractory disease did not impact the outcome after alloSCT. OS was reduced by resistant disease at alloSCT (HR=4.01, CI95% 1.34-11.97, p=0.012) and by T-depleted haploidentical graft (HR=3.81, CI95% 1.36-10.66, p=0.010). PFS and relapse incidence were impacted only by resistant disease (HR=5.54, CI95% 2.13-14.37, p<0.001, and HR=6.75, CI95% 2.07-21.96, p=0.001, respectively). NRM was significantly increased in the T-depleted haploidentical transplant (HR=7.63, CI95% 1.07-54.31, p=0.042). In conclusion, only the disease pre-transplant status, not the timing of relapse after ASCT or primary refractory disease, influenced OS, PFS and relapse of alloSCT. The deepest response should be pursued before alloSCT to have the best results from it and this might be possible in the era of novel agents.

Authors

  • F. Spina
  • S. Dalto
  • Philippis C. De
  • A. Dodero
  • L. Farina
  • V. Montefusco
  • S. Viviani
  • P. Corradini