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Rituximab as adjunctive therapy to BEAM conditioning for autologous stem cell transplantation in Hodgkin lymphoma

Bone Marrow Transplantation volume 57, pages 579–585 (2022)Cite this article

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Abstract

While high-dose chemotherapy followed by autologous stem cell transplantation (ASCT) leads to improved disease-free survival (DFS) for children and adults with relapsed/refractory Hodgkin lymphoma (HL), relapse remains the most frequent cause of mortality post-transplant. Rituximab has been successfully incorporated into regimens for other B-cell lymphomas, yet there have been limited studies of rituximab in HL patients. We hypothesized that adding rituximab to BEAM (carmustine, etoposide, cytarabine, melphalan) conditioning would reduce relapse risk in HL patients post-transplant. Here, we retrospectively review the outcomes of patients with relapsed/refractory HL who received rituximab in addition to BEAM. The primary outcome was DFS. Our cohort included 96 patients with a median age of 28 years (range, 6–76). Majority of patients (57%) were diagnosed with advanced (Stage III–IV) disease, and 62% were PET negative pre-transplant. DFS was 91.5% at 1 year [95% CI 86–98%], and 78% at 3 years [95% CI 68–88%]. NRM was 0% and 3.5% at 1-year [95% CI 0–3%] and 3-years [95% CI 0–8.5%], respectively. 25% of patients developed delayed neutropenia, with 7% requiring infection-related hospitalizations, and one death. We have demonstrated excellent outcomes for patients receiving rituximab with BEAM conditioning for relapsed/refractory HL. Future comparative studies are needed to better determine whether rituximab augments outcomes post-transplant.

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Fig. 1
Fig. 2: Survival outcomes for entire cohort.
Fig. 3: Predictors of 3-year DFS.

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Acknowledgements

We would like to acknowledge Malcolm K. Brenner and Catherine Gillespie for their assistance in editing the manuscript. We would like also to thank the Center for International Blood and Marrow Transplant Research (CIBMTR) for providing us with the data to perform a comparative analysis. The data presented here are preliminary and were obtained from the Statistical Center of the Center for International Blood and Marrow Transplant Research. The analysis has not been reviewed or approved by the Advisory or Scientific Committees of the CIBMTR.

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Authors and Affiliations

  1. Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA

    Brian D. Friend, Tami D. John, Baheyeldin Salem, Saleh Bhar, Erin E. Doherty, John Craddock, Ghadir Sasa, Mengfen Wu, Tao Wang, Caridad Martinez, Robert A. Krance & Helen E. Heslop

  2. Department of Medicine, Houston Methodist Hospital, Houston, TX, USA

    Ibrahim N. Muhsen

  3. Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA

    Shreeya Patel

  4. Center for Cell and Gene Therapy, Baylor College of Medicine, Houston Methodist Hospital, Houston, TX, USA

    LaQuisa C. Hill, Premal Lulla, Carlos A. Ramos, Rammurti T. Kamble, Mengfen Wu, Tao Wang, Helen E. Heslop & George Carrum

  5. Houston Methodist Cancer Center, Houston, TX, USA

    S. Ravi Pingali

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Contributions

Contribution: BDF and IM drafted the manuscript; BDF, MW, and TW performed statistical analyses; RAK, HEH, and GC designed the study; BDF, IM, and SP performed data collection; TDJ, BS, SB, EED, JC, GS, LCH, PL, CAR, SRP, RTK, CM, RAK, HEH, GC contributed patients and edited the manuscript. All authors approved the final version of the manuscript.

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Correspondence to Brian D. Friend.

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HEH is a current equity holder in Allovir, Marker Therapeutics; has been a member on a Board of Directors or advisory committee for Fresh Wind Biotherapies, Gilead, GlaxoSmithKline, Kiadis, Novartis, Takeda, Tessa Therapeutics; and has received research funding from Kuur Therapeutics and Tessa Therapeutics.

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Friend, B.D., Muhsen, I.N., Patel, S. et al. Rituximab as adjunctive therapy to BEAM conditioning for autologous stem cell transplantation in Hodgkin lymphoma. Bone Marrow Transplant 57, 579–585 (2022). https://doi.org/10.1038/s41409-022-01599-5

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