Allogeneic Stem Cell Transplantation for Relapsed Hodgkin’s Disease - a Single Centre Experience

Hodgkin’s disease can be cured by chemotherapy in the majority of cases. However a small proportion of patients show an aggressive course with multiple relapses after chemotherapy including autologous stem cell transplantation. Whether allogeneic stem cell transplantation constitutes a valid therapeutic option for these patients remains highly controversial. We report on our experience on 9 patients with Hodgkin’s disease receiving an allogeneic stem cell transplant from matched related (n=3), matched unrelated (n=1) or mismatched unrelated (2× 9/10, 2 ×8/10, 1× 7/10) donors. Median age was 28 years (range 18 – 35). All patients were extensively pre-treated including high-dose chemotherapy with autologous stem cell transplantation in 8 of 9 cases. The disease status before transplantation was CR (n=1), PR (n=5), SD (n=2) or progressive disease in 1 case. Conditioning treatment consisted of fludarabine 30 mg/m2 day -8 to -4, melphalan 70 mg/m2 day -3 to -2 and ATG 10–20 mg/kg day -4 to -2. Ciclosporin A and short course methotrexate was used for prophylactic immunosuppression. All patients showed prompt engraftment. Acute GvHD was found in 2 patients (Grade IV n=1, Grade I n=1), chronic GvHD did not occur after a median follow up of 471 days for the surviving patients. Two patients died from treatment-related causes, one from GvHD and one from septicemia. Estimated 2 year survival is 78%. Three patients have relapsed so far at day 128, 192 and 201 post transplant and received donor lymphocyte infusions or chemotherapy. The estimated 2 year disease free survival is 57%. Our results show a good feasibility of an allogeneic stem cell transplantation with reduced intensity conditioning for relapsed Hodgkin’s disease despite extensive pre-treatment and mostly partial remissions at transplant. The rate of acute and chronic GvHD was remarkably low in view of the fact, that 5 of 9 patients had mismatched unrelated donors. In summary allogeneic stem cell transplantation should be further exploited as treatment option for refractory and relapsed Hodgkin’s disease in younger patients.