Allogeneic hematopoietic cell transplantation after failed autologous transplant for lymphoma using total lymphoid irradiation and anti-thymocyte globulin conditioning

We describe 47 patients with lymphoma and failed prior autologous hematopoietic cell transplantation (HCT) who received TLI-ATG conditioning followed by allogeneic HCT. Thirtytwo 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, progression-free survival (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) complete remissions 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 overall survival (81% at 3 years). Users may view, print, copy, and download text and data-mine the content in such documents, for the purposes of academic research, subject always to the full Conditions of use:http://www.nature.com/authors/editorial_policies/license.html#terms Corresponding author: Andrew R. Rezvani, Division of Blood & Marrow Transplantation, Stanford University Medical Center, 300 Pasteur Drive, MC 5623, Stanford, CA 94305, [email protected], Phone: (650) 725-4077, Fax: (650) 725-8950. Trial registration: Registered on clinicaltrials.gov as NCT00185640. Conflict of interest disclosure: J.E.B. was a faculty member at Stanford University during the time that this research was conducted, but is now an employee of Amgen. The authors have no other conflicts of interest to disclose. HHS Public Access Author manuscript Bone Marrow Transplant. Author manuscript; available in PMC 2016 April 01. Published in final edited form as: Bone Marrow Transplant. 2015 October ; 50(10): 1286–1292. doi:10.1038/bmt.2015.149. A uhor M anscript