1. ¹Department of Haematology, Royal Free and University College Medical School, London, UK
2. ²Department of Haematology, British National Lymphoma Investigation, London, UK
3. ³Department of Haematology, Christie Hospital, Manchester, UK
4. ⁴Department of Haematology, Leicester Royal Infirmary, Leicester, UK
5. ⁵Department of Haematology, Glasgow Royal Infirmary, Glasgow, UK
6. ⁶Department of Haematology, St George's Hospital, London, UK
7. ⁷Department of Haematology, Heartlands Hospital, Birmingham, UK

Correspondence: Dr KJ Thomson, Department of Haematology, Royal Free and University College Medical School, 98 Chenies Mews, London WC1E 6HX, UK. E-mail: kirsty.thomson@uclh.nhs.uk

⁸These authors contributed equally to the study.

Received 3 July 2007; Revised 30 November 2007; Accepted 30 November 2007; Published online 14 January 2008.

Abstract

This study compares outcome of reduced-intensity conditioned transplant (RIT) with outcome of conventional non-transplant therapy in patients with Hodgkin's lymphoma relapsing following autograft. There were 72 patients in two groups who had relapsed, and received salvage therapy with chemotherapyradiotherapy. One group (n=38) then underwent alemtuzumab-containing RIT. The second group—historical controls (n=34), relapsing before the advent of RIT—had no further high-dose therapy. This group was required to respond to salvage therapy and live for over 12 months post-relapse, demonstrating potential eligibility for RIT, had this been available. Overall survival (OS) from diagnosis was superior following RIT (48% at 10 years versus 15% ; P=0.0014), as was survival from autograft (65% at 5 years versus 15% ; P0.0001). For the RIT group, OS at 5 years from allograft was 51% , and in chemoresponsive patients was 58% , with current progression-free survival of 42% . Responses were seen in 8 of 15 patients receiving donor lymphocyte infusions (DLI) for relapse/progression, with durable remission in five patients at median follow-up from DLI of 45 months (28–55). These data demonstrate the potential efficacy of RIT in heavily pre-treated patients whose outlook with conventional therapy is dismal, and provide evidence of a clinically relevant graft-versus-lymphoma effect.