title: Allogeneic hematopoietic cell transplantation after failed autologous transplant for lymphoma using TLI and anti-thymocyte globulin conditioning.
abstract: We describe 47 patients with lymphoma and failed prior autologous hematopoietic cell transplantation (HCT) who received TLI-ATG (anti-thymocyte globulin) conditioning followed by allogeneic HCT. Thirty-two 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 (OS), 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) CRs 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 OS (81% at 3 years).
authors.affiliation: Division of Blood & Marrow Transplantation, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: A R
authors.initials: AR
authors.lastname: Rezvani
authors.affiliation: Osborn Hematologic Malignancy and Transplantation Program, West Virginia University, Morgantown, WV, USA.
authors.forename: A S
authors.initials: AS
authors.lastname: Kanate
authors.affiliation: Department of Statistics, Stanford University, Stanford, CA, USA.
authors.forename: B
authors.initials: B
authors.lastname: Efron
authors.affiliation: Division of Hematology/Oncology, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: S
authors.initials: S
authors.lastname: Chhabra
authors.affiliation: Division of Blood & Marrow Transplantation, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: H E
authors.initials: HE
authors.lastname: Kohrt
authors.affiliation: Division of Blood & Marrow Transplantation, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Shizuru
authors.affiliation: Division of Blood & Marrow Transplantation, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: G G
authors.initials: GG
authors.lastname: Laport
authors.affiliation: Division of Blood & Marrow Transplantation, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: D B
authors.initials: DB
authors.lastname: Miklos
authors.affiliation: Division of Blood & Marrow Transplantation, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Benjamin
authors.affiliation: Division of Blood & Marrow Transplantation, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: L J
authors.initials: LJ
authors.lastname: Johnston
authors.affiliation: Division of Blood & Marrow Transplantation, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Arai
authors.affiliation: Division of Blood & Marrow Transplantation, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: W-K
authors.initials: WK
authors.lastname: Weng
authors.affiliation: Division of Blood & Marrow Transplantation, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: R S
authors.initials: RS
authors.lastname: Negrin
authors.affiliation: Division of Blood & Marrow Transplantation, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Strober
authors.affiliation: Division of Blood & Marrow Transplantation, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: R
authors.initials: R
authors.lastname: Lowsky
mesh_terms: D000328:Adult; D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019172:Transplantation Conditioning / Q000379:methods*; D014182:Transplantation, Autologous / Q000009:adverse effects*; D014184:Transplantation, Homologous / Q000379:methods*; D055815:Young Adult
chemical_list: D000961:Antilymphocyte Serum