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Posted by on Aug 9, 2020 in Hodgkin's lymphoma | 0 comments

In a nutshell

The study evaluated the outcomes of second autologous stem cell transplantation (ASCT2) in patients with relapsed/refractory Hodgkin lymphoma (r/r-HL) after a first transplantation (ASCT1). The main finding was that ASCT2 was safe and relatively effective in such patients.

Some background

ASCT replaces cancerous bone marrow with healthy stem cells from patients’ own bodies. It is given when HL relapses after initial treatment. 40-50% of patients develop r/r-HL after ASCT. Drugs like brentuximab-vedotin (Adcetris) improve survival in such patients. These patients are generally given allogeneic-SCT (alloSCT) which uses stem cells from donors. However, matching donors are hard to find. Studies supporting the effectiveness of a second ASCT (ASCT2) in such patients are limited.

Methods & findings

The study analyzed previous records of 56 patients with r/r-HL who received ASCT2 after a failed ASCT1. Recovery of neutrophils and platelets to normal levels is important after cancer therapy. Survival and relapse rate were also evaluated.

The average time to neutrophil and platelet recovery after ASCT2 were 11 and 12 days. Complete remission (CR) refers to the disappearance of all cancer symptoms. Partial remission (PR) means at least 50% or more of the symptoms are absent. 52% of patients achieved CR and 12% had PR after 100 days of ASCT2. Cancer progressed in 5% of patients. Another 5% had stable disease, meaning that their cancer neither progressed nor reduced.

Overall, 62% of patients were estimated to survive after 4 years of ASCT2. During this time, 28% of patients were estimated to survive without disease progression. Patients with CR or PR at the time of ASCT2 were defined to have chemosensitive-cancer (CC). Rates of overall survival (OS) were 72% in patients with CC and 29% in those without CC. Relapse rates were 64% for CC and 82% in those without CC. 

The bottom line

The authors concluded that ASCT2 was safe and effective for patients with r/r-HL who had late relapses after ASCT1. It also showed benefits in patients with CC.

The fine print

This study was retrospective, meaning that it looked back in time to analyze data. Information might have been missing. It also did not compare results with a control group receiving no ASCT2 or a different therapy. Further controlled studies are needed.

Published By :

Leukemia & lymphoma

Date :

Jul 11, 2020

Original Title :

Second autologous stem cell transplantation for relapsed/refractory Hodgkin lymphoma after a previous autograft: a study of the lymphoma working party of the EBMT.

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