Gemcitabine fludarabine and melphalan for reduced-intensity conditioning and allogeneic stem cell transplantation for relapsed and refractory Hodgkin lymphoma

摘要

Forty patients with Hodgkin lymphoma underwent an allogeneic stem cell transplant with the gemcitabine-fludarabine-melphalan reduced-intensity conditioning regimen. The median age was 31 years (range 20–63). Thirty-one (77%) had undergone a prior autologous stem cell transplant, and the median time to progression after the transplant was six months (1–68). Disease status at transplant was complete remission/complete remission, undetermined (n=23; 57%), partial remission (n=14; 35%), and other (n=3; 7%). Twenty-six patients (65%) received brentuximab vedotin prior to allotransplant. The overall complete response rate prior to allotransplant was 65% in brentuximab-treated patients vs. 42% in brentuximab-naïve patients (p=0.15). At the latest follow-up (October 2015), thirty-one patients are alive. The median follow-up is 41 months (5–87). Transplant-related mortality at three years is 17%. Pulmonary, skin toxicities and nausea were seen in 13 (33%), 11 (28%), and 37 (93%) patients, respectively. At three years, estimates for overall and progression-free survival are 75% (95% CI: 57–86) and 54% (95% CI: 36–70). Overall incidence for disease progression is 28% (95% CI 16–50). We feel that the gemcitabine-fludarabine-melphalan regimen allows moderate dose-intensification with acceptable morbidity and mortality. The inclusion of gemcitabine affected nausea, pulmonary and likely skin toxicity. Exposure to brentuximab vedotin allowed more patients to reach allogeneic stem cell transplant in complete remission. With over 50% of patients progression-free at 3 years, allogeneic stem cell transplant with reduced-intensity conditioning remains an effective and relevant treatment option for Hodgkin lymphoma in the brentuximab vedotin era.