Outcomes of reduced-intensity conditioning before alloSCT for relapsed or refractory Hodgkin lymphoma

This study investigated the outcomes of reduced-intensity conditioning followed by allogeneic stem cell transplantation (alloSCT) in patients with Hodgkin’s lymphoma (HL). This study concluded that this treatment improved survival outcomes in these patients.

AlloSCT is an effective therapy for patients with HL who relapse after autologous SCT (autoSCT). AlloSCT involves replacing the patient’s cancer cells with healthy stem cells from a donor. In autoSCT, the healthy stem cells come from the patient, after being stored. Patients who relapse (cancer recurrence) or have disease progression (tumor grows or spreads) after autoSCT tend to have poor outcomes. Alternative treatment approaches are needed for these patients.

High-dose chemotherapy is typically used before SCT to get rid of any remaining cancer cells. This type of chemotherapy is called a conditioning regimen. Reduced-intensity conditioning before alloSCT has been associated with fewer side effects and improved survival. Whether this type of conditioning improves outcomes in patients with relapsed or refractory HL remains under investigation.

This study involved 72 patients with HL. 54% of patients had refractory disease. All patients received reduced-intensity conditioning followed by alloSCT. Patients were followed-up for an average of 48 months.

Overall, 43% of patients achieved a complete response (disappearance of all signs of cancer) at 100 days after treatment. 28% of patients achieved a partial response (tumor shrinkage) and 22% had stable disease (tumor neither growing nor shrinking). 

Five-year overall survival (patients still alive 5 years later) was 35%. Five-year progression-free survival (patients still alive 5 years later without disease progression) was 34%.

58% of patients reported infections. 29% of patients developed acute graft-versus-host disease (the donated stem cells attack the patient’s healthy cells; GVHD). 11% of patients developed severe or life-threatening GVHD.

Having chemosensitive (tumor responds to chemotherapy) disease was significantly associated with a 3.07-fold lower risk of disease progression and a 2.7-fold lower risk of mortality.

This study concluded that reduced-intensity conditioning followed by alloSCT may be effective for patients with HL who relapse after autoSCT. The authors suggest that this treatment may not be recommended for patients with refractory disease.

This study was retrospective, meaning it looked back in time to analyze data. Also, the patient population in this study was quite small. Larger studies are needed to confirm these results.