Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Conditioning Regimens

Superiority of reduced-intensity allogeneic transplantation over conventional treatment for relapse of Hodgkin's lymphoma following autologous stem cell transplantation

Bone Marrow Transplantation volume 41, pages 765–770 (2008)Cite this article

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 chemotherapy±radiotherapy. 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%; P⩽0.0001). 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.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3
Figure 4

Similar content being viewed by others

References

  1. Linch DC, Winfield D, Goldstone AH, Moir D, Hancock B, McMillan A et al. Dose intensification with autologous bone-marrow transplantation in relapsed and resistant Hodgkin's disease: results of a BNLI randomised trial. Lancet 1993; 341: 1051–1054.

    Article  CAS  PubMed  Google Scholar 

  2. Schmitz N, Pfistner B, Sextro M, Sieber M, Carella AM, Haenel M et al. Aggressive conventional chemotherapy compared with high-dose chemotherapy with autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkin's disease: a randomised trial. Lancet 2002; 359: 2065–2071.

    Article  CAS  PubMed  Google Scholar 

  3. Milpied N, Fielding AK, Pearce RM, Ernst P, Goldstone AH . Allogeneic bone marrow transplant is not better than autologous transplant for patients with relapsed Hodgkin's disease. European Group for Blood and Bone Marrow Transplantation. J Clin Oncol 1996; 14: 1291–1296.

    Article  CAS  PubMed  Google Scholar 

  4. Vose JM, Bierman PJ, Anderson JR, Kessinger A, Pierson J, Nelson J et al. Progressive disease after high-dose therapy and autologous transplantation for lymphoid malignancy: clinical course and patient follow-up. Blood 1992; 80: 2142–2148.

    CAS  PubMed  Google Scholar 

  5. Varterasian M, Ratanatharathorn V, Uberti JP, Karanes C, Abella E, Momin F et al. Clinical course and outcome of patients with Hodgkin's disease who progress after autologous transplantation. Leuk Lymphoma 1995; 20: 59–65.

    Article  CAS  PubMed  Google Scholar 

  6. Carella AM, Beltrami G, Carella Jr M, Corsetti MT, Scalzulli RP, Greco M . Immunosuppressive non-myeloablative allografting as salvage therapy in advanced Hodgkin's disease. Haematologica 2001; 86: 1121–1123.

    CAS  PubMed  Google Scholar 

  7. Anderlini P, Saliba R, Acholonu S, Okoroji GJ, Donato M, Giralt S et al. Reduced-intensity allogeneic stem cell transplantation in relapsed and refractory Hodgkin's disease: low transplant-related mortality and impact of intensity of conditioning regimen. Bone Marrow Transplant 2005; 35: 943–951.

    Article  CAS  PubMed  Google Scholar 

  8. Peggs KS, Hunter A, Chopra R, Parker A, Mahendra P, Milligan D et al. Clinical evidence of a graft-versus-Hodgkin's-lymphoma effect after reduced-intensity allogeneic transplantation. Lancet 2005; 365: 1934–1941.

    Article  PubMed  Google Scholar 

  9. Gajewski JL, Phillips GL, Sobocinski KA, Armitage JO, Gale RP, Champlin RE et al. Bone marrow transplants from HLA-identical siblings in advanced Hodgkin's disease. J Clin Oncol 1996; 14: 572–578.

    Article  CAS  PubMed  Google Scholar 

  10. Akpek G, Ambinder RF, Piantadosi S, Abrams RA, Brodsky RA, Vogelsang GB et al. Long-term results of blood and marrow transplantation for Hodgkin's lymphoma. J Clin Oncol 2001; 19: 4314–4321.

    Article  CAS  PubMed  Google Scholar 

  11. Anderson JE, Litzow MR, Appelbaum FR, Schoch G, Fisher LD, Buckner CD et al. Allogeneic, syngeneic, and autologous marrow transplantation for Hodgkin's disease: the 21-year Seattle experience. J Clin Oncol 1993; 11: 2342–2350.

    Article  CAS  PubMed  Google Scholar 

  12. Tsai T, Goodman S, Saez R, Schiller G, Adkins D, Callander N et al. Allogeneic bone marrow transplantation in patients who relapse after autologous transplantation. Bone Marrow Transplant 1997; 20: 859–863.

    Article  CAS  PubMed  Google Scholar 

  13. di Grazia C, Raiola AM, Van Lint MT, Lamparelli T, Gualandi F, Berisso G et al. Conventional hematopoietic stem cell transplants from identical or alternative donors are feasible in recipients relapsing after an autograft. Haematologica 2001; 86: 646–651.

    CAS  PubMed  Google Scholar 

  14. Robinson SP, Goldstone AH, Mackinnon S, Carella A, Russell N, de Elvira CR et al. Chemoresistant or aggressive lymphoma predicts for a poor outcome following reduced-intensity allogeneic progenitor cell transplantation: an analysis from the Lymphoma Working Party of the European Group for Blood and Bone Marrow Transplantation. Blood 2002; 100: 4310–4316.

    Article  CAS  PubMed  Google Scholar 

  15. Faulkner RD, Craddock C, Byrne JL, Mahendra P, Haynes AP, Prentice HG et al. BEAM-alemtuzumab reduced-intensity allogeneic stem cell transplantation for lymphoproliferative diseases: GVHD, toxicity, and survival in 65 patients. Blood 2004; 103: 428–434.

    Article  CAS  PubMed  Google Scholar 

  16. Corradini P, Zallio F, Mariotti J, Farina L, Bregni M, Valagussa P et al. Effect of age and previous autologous transplantation on nonrelapse mortality and survival in patients treated with reduced-intensity conditioning and allografting for advanced hematologic malignancies. J Clin Oncol 2005; 23: 6690–6698.

    Article  CAS  PubMed  Google Scholar 

  17. Porter DL, Stadtmauer EA, Lazarus HM . ‘GVHD’: graft-versus-host disease or graft-versus-Hodgkin's disease? An old acronym with new meaning. Bone Marrow Transplant 2003; 31: 739–746.

    Article  CAS  PubMed  Google Scholar 

  18. Anderlini P, Acholonu SA, Okoroji GJ, Andersson BS, Couriel DR, De Lima MJ et al. Donor leukocyte infusions in relapsed Hodgkin's lymphoma following allogeneic stem cell transplantation: CD3+ cell dose, GVHD and disease response. Bone Marrow Transplant 2004; 34: 511–514.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. K J Thomson and K S Peggs: These authors contributed equally to the study.

Authors and Affiliations

  1. Department of Haematology, Royal Free and University College Medical School, London, UK

    K J Thomson, K S Peggs, E C Morris, A H Goldstone, D C Linch & S Mackinnon

  2. Department of Haematology, British National Lymphoma Investigation, London, UK

    P Smith

  3. Department of Haematology, Christie Hospital, Manchester, UK

    J Cavet

  4. Department of Haematology, Leicester Royal Infirmary, Leicester, UK

    A Hunter

  5. Department of Haematology, Glasgow Royal Infirmary, Glasgow, UK

    A Parker

  6. Department of Haematology, St George's Hospital, London, UK

    R Pettengell

  7. Department of Haematology, Heartlands Hospital, Birmingham, UK

    D Milligan

Authors
  1. K J Thomson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K S Peggs
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J Cavet
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A Hunter
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A Parker
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. R Pettengell
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. D Milligan
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. E C Morris
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. A H Goldstone
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. D C Linch
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. S Mackinnon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K J Thomson.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Thomson, K., Peggs, K., Smith, P. et al. Superiority of reduced-intensity allogeneic transplantation over conventional treatment for relapse of Hodgkin's lymphoma following autologous stem cell transplantation. Bone Marrow Transplant 41, 765–770 (2008). https://doi.org/10.1038/sj.bmt.1705977

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.bmt.1705977

Keywords

This article is cited by

Search

Advanced search

Quick links