Allogeneic Stem Cell Transplantation For Primary Refractory Hodgkin's Disease: Ablative Vs Reduced Intensity

Minority of patients with Hodgkin’s lymphoma (HL) are primary refractory or relapse very early after first-line chemotherapy or even after high-dose chemotherapy (HDCT) and autologous HSCT. The dismal outcome of these patients was shown by many previous studies. We evaluated the role of allogeneic stem cell transplantation in this setting. We retrospectively analysed 6 consecutive patients (med age 45) with primary refractory advanced stage Hodgkin’s lymphoma transplanted between 2011-2013. The median time from initial diagnosis and from autologous HSCT to allogeneic transplantation was 44.1 mo.s and 12.4 mo.s, respectively. The donor sources were sibling in 4, unrelated in one and haploidentical in 1. The conditioning regimen was myeloablative (BU-CY) in 3 and reduced intensity (Flu-Mel±ATG) in 3 adjusted according to their age and comorbid conditions. All of them received peripheral blood stem cells. Engraftment failure was not observed. None of them were complicated with VOD or other early complications of HSCT. Day 100 transplantation related mortality was 16.7% (1 patient). The patient succumbed to carbapenemase+ klebsiella pneumonia sepsis on day +11. Median follow up of the surviving patients was 14.65 months (range, 6-26). At the last follow up 3 of them were in CR, one patient had progression after HSCT and achieved stable disease with brentuximab and DLI. One patient died from acute abdominal infection on +187 while in CR. Only one patient was complicated with both acute and chronic GVHD (unrelated HSCT). The myeloablative regimen was tolerated well and the patients achieved durable remission. The expired patients were both in RIC arm. Although the number of transplanted patients is low we can conclude that allogeneic HSCT using myeloablative regimen is safe and effective in short term. Primary refractory HL patients should be evaluated for allogeneic HSCT, as upfront or following failure of autologous HSCT and HDCT. Ablative regimen is tolerated as well as RIC, and more effective than allo RIC for disease control in the light of our current limited cohort.