The effects of tandem autologous-reduced intensity allogeneic stem cell transplantation in patients with high-risk relapsed Hodgkin lymphoma

The study evaluated outcomes of tandem autologous stem cell transplantation (ASCT) – reduced-intensity conditioning (RIC) allogeneic stem cell transplantation (alloSCT) in patients with high-risk (HR) relapsed Hodgkin lymphoma (HL). The main finding was that this approach was safe and effective in such patients.

A stem cell transplant (SCT) uses chemotherapy or radiotherapy (conditioning therapy) to kill cancer cells that are replaced by healthy blood-cell forming stem cells. ASCT uses patients' own stem cells to replace cancerous bone marrow. It is commonly curative for HL. However, it can fail to treat patients with a higher risk of HL relapse.

Allo-SCT uses stem cells from matched donors. It can improve outcomes in such patients with high risks of relapse. RIC uses less chemotherapy or radiation to make patients’ bone marrow ready for transplants. A tandem (T) ASCT-RIC-alloSCT means that an allo-SCT is performed with RIC within 6-months of an ASCT. T-ASCT-RIC-alloSCT has previously improved outcomes while reducing mortality in relapsed HR-HL in few patients. Data from larger populations are needed.

The study analyzed the records of 126 adult patients with relapsed HR-HL. They received an ASCT as the first transplant and then a RIC-alloSCT within 6 months, with no relapse between the procedures. On average, patients had 2 prior therapies before receiving ASCT within 16 months of diagnosis. Patients were followed up for 44 months on average.

33% of patients experienced a relapse. 53% of patients were alive at 3 years without cancer worsening. Overall, 73% of patients were estimated to survive for 3 years. 

Acute graft-versus-host disease (aGVHD) is a side effect of alloSCT where the donor’s immune cells attack host tissues. The risk of developing moderate to severe aGVHD within 100 days of alloSCT was 10%. The risk of chronic GVHD, which occurs after 100 days of alloSCT, was 26% within 3 years.

The study concluded that T-ASCT-RIC-alloSCT showed promising outcomes in patients with HR relapsed HL.

The study looked back in time to analyze patients’ data. It also did not compare the effectiveness and safety of T-ASCT-RIC-alloSCT with any control therapy.