The role of stem cell transplantation in Hodgkin lymphoma treatment

This study summarized guidelines for the role of stem cell transplantation in patients with Hodgkin lymphoma.

While Hodgkin lymphoma is a curable disease in many, some patients experience a disease relapse or they do not respond to treatment. These patients are often treated with further chemotherapy followed by a stem cell transplant. Stem cells are immature blood cells that can develop into the different types of blood cells needed by the body.

The American Society for Blood and Marrow Transplantation assembled a panel of experts to review previous research. They offer guidelines on the use of stem cell transplantation in Hodgkin lymphoma.

This study summarized the recommendations of the experts.

An autologous stem cell transplant (ASCT) uses stem cells harvested from the patient. The stem cells are infused after a course of high-dose chemotherapy. This is a treatment option for patients who relapsed or did not respond to treatment. In a study of 161 patients who relapsed, ASCT significantly improved the 3-year freedom from treatment failure rate (55%) compared to chemotherapy alone (34%). There was no significant difference in overall survival (time from treatment until death from any cause).

Patients generally undergo salvage chemotherapy (treatment with a different combination) before high-dose chemotherapy and ASCT. A common combination is ICE (ifosfamide, carboplatin, and etoposide). One study noted an 88% response rate to two cycles of ICE. A better response to salvage chemotherapy has been associated with improved survival following ASCT.

High-dose chemotherapy is recommended before transplant. BEAM (BCNU, etoposide, cytarabine, and melphalan) is commonly used. Radiation can also be used in patients with bulky disease (a large tumor in the chest) who have not been previously treated with radiation.

Following transplantation, treatment with brentuximab vedotin (Adcetris) is recommended for patients with high-risk disease. Treatment with brentuximab vedotin led to a 2-year progression-free survival (time from treatment until disease progression) of 65%. This was compared to 45% in those treated with a placebo (substance with no effect on the body). Brentuximab vedotin is also being researched as a treatment prior to ASCT.

An allogenic stem cell transplant may be used in patients who progress after ASCT. This treatment uses donor stem cells. A benefit of this type of transplant is the graft-versus-lymphoma effect. This is when the donor cells begin to attack the cancer cells. One study reported a response to treatment rate of 79% due to this effect.

Survivors of stem cell transplantation can face long-term complications. One study examined 10 year and more survivors of transplantation. Survivors were 5.7 times as likely to experience severe or life threatening conditions.

The guidelines summarized recommend stem cell transplantation as a treatment for Hodgkin lymphoma that has relapsed or not responded to treatment. Further research is recommended on methods of reducing the risk of relapse following transplant.