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Outcome of Tandem Autologous/Allogeneic Hematopoietic Cell Transplantation in High-Risk Non Hodgkin's Lymphoma Patients: Stanford University Experience

Track: Poster Abstracts
Wednesday, February 26, 2014, 6:45 PM-7:45 PM
Longhorn Hall E (Exhibit Level 1) (Gaylord Texan)
Kitsada Wudhikarn, MD , Division of Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, CA
Philip Lavori, PhD , Health Research and Policy, Biostatistics, Stanford University School of Medicine, Stanford, CA
Sally Arai, MD , Division of Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, CA
Laura Johnston, MD , Division of Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, CA
Ginna G. Laport, MD , Division of Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, CA
Robert Lowsky, MD , Division of Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, CA
David B. Miklos, MD, PhD , Division of Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, CA
Judith A. Shizuru, MD, PhD , Division of Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, CA
Richard T Hoppe, MD , Radiation Oncology, Stanford University Medical Center, Stanford, CA
Jonathan Benjamin, MD, PhD , Division of Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, CA
Everett Meyer, MD, PhD , Division of Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, CA
Robert Negrin, MD , Division of Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, CA
Wen-Kai Weng, MD , Division of Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, CA
Introduction: Survival outcomes of chemotherapy resistant/refractory, relapsed and other high-risk Non Hodgkin’s Lymphoma (NHL) patients are poor despite available salvage treatment strategies including immunotherapy, high dose chemotherapy and autologous hematopoietic cell transplant (HCT). Optimal subsequent therapies currently are not well defined. We explored the outcomes including efficacy and toxicities of the novel strategy with tandem autologous HCT followed by non-myeloablative (NMA) allogeneic HCT using total lymphoid irradiation and anti-thymocyte globulin regimen in high-risk NHL patients.

Method: Between November 2007 and December 2012, histologically proven NHL patients with high-risk features were prospectively enrolled to the institutional based tandem autologous HCT followed by NMA allogeneic HCT protocol (tandem HCT). Pre-transplant characteristics and transplant related parameters were recorded. We analyzed and reported post-transplant outcomes including event free survival (EFS), overall survival (OS), toxicities and adverse events.

Results:  A total of 34 high-risk NHL patients were enrolled to the study between 2007 and 2012. Median age at autologous HCT was 59 years (range, 30-69 years). Diagnosis included 17 transformed diffuse large B cell lymphoma (DLBCL), 7 high-risk T cell NHL, 6 relapsed/refractory DLBCL, 2 double-hit NHL, and 2 refractory follicular lymphoma. Twelve patients were able to complete the pre-planned tandem HCT. Median duration between autologous and allogeneic HCT was 84.5 days (range, 66-211 days). Of 22 patients who did not undergo the pre-planned tandem HCT, three had allogeneic HCT under other available institutional based protocols. At the time of data analysis, with the median duration of follow up of 10 months, median EFS and OS for the entire group were 6.4 months and 13.3 months respectively. In 12 patients who underwent tandem HCT, median EFS and OS were 37.7 months and not reached respectively. The major causes of death were disease relapse (14 patients, 41.2%) and transplant related complication (5 patients, 14.7%). Of 12 tandem HCT patients, two patients (16.7%) died from disease relapse.

Conclusion: Survival outcomes of high-risk NHL are poor. Tandem autologous/allogeneic HCT might be a feasible and effective approach in these very high-risk patients. The most common cause of treatment failure remained disease relapse in these high-risk patients. Proper identification and selection of high risk NHL who will benefit from tandem autologous/allogeneic transplantation are challenging and warrant further studies.

Disclosures:
Nothing To Disclose
See more of: Poster Session 1: Lymphoma/Multiple Myeloma
See more of: Poster Abstracts
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