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Outcomes of adults with lymphoma treated with nonmyeloablative TLI-ATG and radiation boost to high risk or residual disease before allogeneic hematopoietic cell transplant

Abstract

We evaluated the impact on survival of antithymocyte globulin conditioning (TLI-ATG) with radiation (RT) boost to high risk or residual disease before allogeneic hematopoietic cell transplant (allo-HCT) for adults with lymphoma (excluding mycosis fungoides and low-grade NHL other than SLL/CLL). Of 251 evaluable patients, 36 received an RT boost within 3 months of allo-HCT at our institution from 2001 to 2016. At the time of TLI-ATG, patients who received boost vs no boost had a lower rate of CR (11% vs 47%, p = 0.0003), higher rates of bulky disease (22% vs 4%, p < 0.0001), extranodal disease (39% vs 5%, p < 0.0001), and positive PET (75% vs 28%, p < 0.00001). In the boost group, the median (range) largest axial lesion diameter was 5.2 cm (1.8–22.3). Median follow-up was 50.2 months (range: 1–196). There was no significant difference in OS, time to recurrence, or time to graft failure with vs without boost. A trend toward higher percent donor CD3+ chimerism was seen with vs without boost (p = 0.0819). The worst boost-related toxicity was grade 2 dermatitis. RT boost may help successfully mitigate the risk of high risk or clinically evident residual disease in adults with lymphoma undergoing allo-HCT.

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Fig. 1: Time-to-event outcomes.
Fig. 2: Case example.
Fig. 3: Time-to-event outcomes stratified by risk factors and boost group.
Fig. 4: Percent donor CD3+ chimerism.

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Acknowledgements

This work was funded in part by the National Institutes of Health, National Cancer Institute grant P01 CA049605.

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RTH and SMH devised the study and edited the manuscript. MLD developed the study, assisted in gathering data, and wrote the manuscript. ALJ assisted in gathering data, produced the figures, and edited the manuscript. RVE performed the analyses and edited the manuscript. MAS assisted in gathering data and edited the manuscript. RHA and RL edited the manuscript.

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Correspondence to R. T. Hoppe.

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Dworkin, M.L., Jiang, A.L., Von Eyben, R. et al. Outcomes of adults with lymphoma treated with nonmyeloablative TLI-ATG and radiation boost to high risk or residual disease before allogeneic hematopoietic cell transplant. Bone Marrow Transplant (2021). https://doi.org/10.1038/s41409-021-01495-4

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