We describe 47 patients with lymphoma and failed prior autologous hematopoietic cell transplantation (HCT) who received TLI-ATG (anti-thymocyte globulin) conditioning followed by allogeneic HCT. Thirty-two patients had non-Hodgkin lymphoma (NHL; diffuse large B-cell lymphoma (n=19), T-cell NHL (n=6), mantle cell lymphoma (n=4) or other B-cell subtypes (n=3)), and 15 had Hodgkin lymphoma. The median follow-up was 4.9 (range, 2.1–11.9) years. The cumulative incidence of grade II–IV acute GvHD at day +100 was 12%, and the cumulative incidence of extensive chronic GvHD at 1 year was 36%. The 3-year cumulative incidences of overall survival (OS), PFS and non-relapse mortality (NRM) were 81%, 44% and 7%, respectively. Fifteen patients died (relapse, n=10; NRM, n=5). Among the 25 patients with relapse after allogeneic HCT, 11 (44%) achieved durable (>1 year) CRs following donor lymphocyte infusion or chemoradiotherapy. The majority of surviving patients (75%; n=24) were able to discontinue all immunosuppression. For patients with relapsed lymphoma after autologous HCT, allogeneic HCT using TLI-ATG conditioning is a well-tolerated, predominantly outpatient therapy with low NRM (7% at 3 years), a low incidence of GvHD, durable disease control and excellent OS (81% at 3 years).
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This study was funded by P01 CA049605 and P01 HL075462 (National Institutes of Health, Bethesda, MD). ARR is supported by a Mentored Research Scholar Grant (12-162-01-LIB) from the American Cancer Society. The study design was conceived by RL and SS Statistical analysis was performed by ARR and BE. The manuscript was drafted by ARR, ASK and RL, and all authors participated in revising the manuscript. All authors participated in data collection and analysis, and all authors approved the submitted manuscript.
JEB was a faculty member at Stanford University during the time that this research was conducted, but is now an employee of Amgen. The remaining authors declare no conflict of interest.
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Rezvani, A., Kanate, A., Efron, B. et al. Allogeneic hematopoietic cell transplantation after failed autologous transplant for lymphoma using TLI and anti-thymocyte globulin conditioning. Bone Marrow Transplant 50, 1286–1292 (2015). https://doi.org/10.1038/bmt.2015.149
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