Impact of graft-versus-lymphoma effect on outcomes after reduced intensity conditioned-alemtuzumab allogeneic haematopoietic stem cell transplantation for patients with mature lymphoid malignancies
Charlotte K. Brierley
Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
Search for more papers by this authorFrancesca M. Jones
Centre for Clinical Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
Search for more papers by this authorKatharine Hanlon
Department of Haematology, Beatson West of Scotland Cancer Centre, Glasgow, UK
Search for more papers by this authorAndy J. Peniket
Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
Search for more papers by this authorChris Hatton
Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
Search for more papers by this authorGraham P. Collins
Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
Search for more papers by this authorAnna Schuh
Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
Search for more papers by this authorPatrick Medd
Department of Haematology, Plymouth Hospitals NHS Trust, Plymouth, UK
Search for more papers by this authorAndrew Clark
Department of Haematology, Beatson West of Scotland Cancer Centre, Glasgow, UK
Search for more papers by this authorJanice Ward
Centre for Clinical Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
Search for more papers by this authorSridar Chaganti
Centre for Clinical Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
Search for more papers by this authorRam Malladi
Centre for Clinical Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
Search for more papers by this authorAnne Parker
Department of Haematology, Beatson West of Scotland Cancer Centre, Glasgow, UK
Search for more papers by this authorCharles Craddock
Centre for Clinical Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
Search for more papers by this authorRobert Danby
Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
Search for more papers by this authorCorresponding Author
Vanderson Rocha
Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
Serviço de Hematologia, Hemoterapia e Terapia Celular, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
Correspondence: Vanderson Rocha, Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, OX3 7LE, UK.
E-mail: [email protected]
Search for more papers by this authorCharlotte K. Brierley
Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
Search for more papers by this authorFrancesca M. Jones
Centre for Clinical Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
Search for more papers by this authorKatharine Hanlon
Department of Haematology, Beatson West of Scotland Cancer Centre, Glasgow, UK
Search for more papers by this authorAndy J. Peniket
Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
Search for more papers by this authorChris Hatton
Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
Search for more papers by this authorGraham P. Collins
Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
Search for more papers by this authorAnna Schuh
Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
Search for more papers by this authorPatrick Medd
Department of Haematology, Plymouth Hospitals NHS Trust, Plymouth, UK
Search for more papers by this authorAndrew Clark
Department of Haematology, Beatson West of Scotland Cancer Centre, Glasgow, UK
Search for more papers by this authorJanice Ward
Centre for Clinical Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
Search for more papers by this authorSridar Chaganti
Centre for Clinical Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
Search for more papers by this authorRam Malladi
Centre for Clinical Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
Search for more papers by this authorAnne Parker
Department of Haematology, Beatson West of Scotland Cancer Centre, Glasgow, UK
Search for more papers by this authorCharles Craddock
Centre for Clinical Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
Search for more papers by this authorRobert Danby
Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
Search for more papers by this authorCorresponding Author
Vanderson Rocha
Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
Serviço de Hematologia, Hemoterapia e Terapia Celular, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
Correspondence: Vanderson Rocha, Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, OX3 7LE, UK.
E-mail: [email protected]
Search for more papers by this authorSummary
Allogeneic haematopoietic stem cell transplant (allo-HSCT) offers potentially curative therapy for patients with relapsed/refractory lymphoid malignancies. Reduced-intensity conditioning (RIC) with Alemtuzumab reduces transplant-related mortality and graft-versus-host disease (GvHD), but may be associated with increased risk of relapse. With the aim of studying the effect of GVHD and donor lymphocyte infusions (DLI) on relapse, we performed a retrospective study of 288 patients (57% non-Hodgkin lymphoma, 24% Hodgkin lymphoma and 19% chronic lymphocytic leukaemia; 58% were relapsed/refractory) who underwent RIC-Alemtuzumab-HSCT between 2000 and 2012. Median follow-up time for survivors was 64 months. Five-year overall survival, relapse incidence, GvHD/relapse-free survival and non-relapse mortality were 47%, 33%, 37% and 28% respectively. Cumulative incidence of grade II-IV acute and extensive chronic GvHD was 22% and 21% at 100 days and 5 years respectively. On multivariate analysis, presence of GvHD (P = 0·03) and unrelated donor type (P = 0·03) were protective of relapse. 62/288 patients received DLI for either mixed donor chimerism (prophylactic DLI, n = 37) or clinical relapse (therapeutic DLI, n = 25). Prophylactic and therapeutic DLI successfully converted the patient to full or stable mixed donor chimerism in 78% and 56% of patients respectively. These data demonstrate good long-term outcomes and support the concept of the graft-vs-lymphoma effect as a key protective factor against relapse following RIC-Alemtuzumab allo-HSCT for patients with mature lymphoid malignancies.
Supporting Information
| Filename | Description |
|---|---|
| bjh15685-sup-0001-TableSI.docxWord document, 13.2 KB | Table SI. Causes of death (n = 155). |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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