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A total of 168 patients with Hodgkin's lymphoma undergoing a first allogeneic stem cell transplantation [reduced intensity conditioning (RIC), n=89; myeloablative conditioning, n=79] between January 1997 and December 2001 were compared. Nonrelapse mortality was significantly decreased in the RIC group, overall survival was better in the RIC group, and there was a trend for better progression-free survival in the RIC group. The development of chronic graft-versus- host disease significantly decreased the incidence of relapse, which translated into a trend for a better progres-sion- free survival
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Allogeneic stem cell transplantation after reduced intensity conditioning in patients with relapsed or refractory Hodgkin's lymphoma. Results of the HDR-ALLO study - A prospective clinical trial by the Grupo Español de Linfomas/Trasplante de Médula Osea (GEL/TAMO) and the Lymphoma Working Party of the European Group for Blood and Marrow Transplantation
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In this phase II study, 92 patients with relapsed Hodgkin's lymphoma were treated with salvage chemotherapy followed by reduced-intensity allogeneic transplantation. Seventy-eight patients proceeded to allograft. Fludarabine (150 mg/m(2) iv) and melphalan (140 mg/m(2) iv) were used as the conditioning regimen. The nonrelapse mortality rate was 8% at 100 days and 15% at 1 year. Relapse was the major cause of failure. The progression-free survival rate was 47% at 1 year and 18% at 4 years from trial entry. The overall survival rate was 71% at 1 year and 43% at 4 years. Chronic graft-versus-host disease was associated with a lower incidence of relapse. Patients allografted in complete remission had a significantly better outcome
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•• Sureda A, Canals C, Arranz R, et al. Allogeneic stem cell transplantation after reduced intensity conditioning in patients with relapsed or refractory Hodgkin's lymphoma. Results of the HDR-ALLO study - a prospective clinical trial by the Grupo Español de Linfomas/Trasplante de Médula Osea (GEL/TAMO) and the Lymphoma Working Party of the European Group for Blood and Marrow Transplantation. Haematologica. 2012;97:310-7. In this phase II study, 92 patients with relapsed Hodgkin's lymphoma were treated with salvage chemotherapy followed by reduced-intensity allogeneic transplantation. Seventy-eight patients proceeded to allograft. Fludarabine (150 mg/m(2) iv) and melphalan (140 mg/m(2) iv) were used as the conditioning regimen. The nonrelapse mortality rate was 8% at 100 days and 15% at 1 year. Relapse was the major cause of failure. The progression-free survival rate was 47% at 1 year and 18% at 4 years from trial entry. The overall survival rate was 71% at 1 year and 43% at 4 years. Chronic graft-versus-host disease was associated with a lower incidence of relapse. Patients allografted in complete remission had a significantly better outcome.
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Forty-nine patients with multiply relapsed Hodgkin's lymphoma were allografted using in vivo T-cell depletion as graft-versus-host disease prophylaxis. Eight of 49 (16%) had grade II-IV acute GVHD and 7 (14%) had chronic GVHD before donor-lymphocyte infusion. Sixteen (33%) patients received donor-lymphocyte infusion from 3 months after transplantation for residual disease or progression. Nonrelapse-related mortality was 16.3% at 730 days. Projected 4-year overall and progression-free survival were 55.7% and 39%, respectively
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•• Peggs KS, Kayani I, Edwards N, et al. Donor lymphocyte infusions modulate relapse risk in mixed chimeras and induce durable salvage in relapsed patients after T-cell-depleted allogeneic transplantation for Hodgkin's lymphoma. J Clin Oncol. 2011;29:971-8. Forty-nine patients with multiply relapsed Hodgkin's lymphoma were allografted using in vivo T-cell depletion as graft-versus-host disease prophylaxis. Eight of 49 (16%) had grade II-IV acute GVHD and 7 (14%) had chronic GVHD before donor-lymphocyte infusion. Sixteen (33%) patients received donor-lymphocyte infusion from 3 months after transplantation for residual disease or progression. Nonrelapse-related mortality was 16.3% at 730 days. Projected 4-year overall and progression-free survival were 55.7% and 39%, respectively.
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Peggs, K.S.1
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Results of a pivotal Phase II study of brentuximab vedotin for patients with relapsed or refractory Hodgkin's lymphoma
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The efficacy and safety of brentuximab vedotin were evaluated in patients with relapsed or refractory Hodgkin's lymphoma after autologous stem-cell transplantation. A total of 102 patients were treated with brentuximab vedotin 1.8 mg/kg by intravenous infusion every 3 weeks. In the absence of disease progression or prohibitive toxicity, patients received a maximum of 16 cycles. The overall response rate was 75% with complete remission in 34% of patients. The median progression-free survival time for all patients was 5.6 months, and the median duration of response for those in CR was 20.5 months. The most common treatment-related adverse events were peripheral sensory neuropathy, nausea, fatigue, neutropenia, and diarrhea
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•• Younes A, Gopal AK, Smith SE, et al. Results of a pivotal Phase II study of brentuximab vedotin for patients with relapsed or refractory Hodgkin's lymphoma. J Clin Oncol. 2012;30:2183-9. The efficacy and safety of brentuximab vedotin were evaluated in patients with relapsed or refractory Hodgkin's lymphoma after autologous stem-cell transplantation. A total of 102 patients were treated with brentuximab vedotin 1.8 mg/kg by intravenous infusion every 3 weeks. In the absence of disease progression or prohibitive toxicity, patients received a maximum of 16 cycles. The overall response rate was 75% with complete remission in 34% of patients. The median progression-free survival time for all patients was 5.6 months, and the median duration of response for those in CR was 20.5 months. The most common treatment-related adverse events were peripheral sensory neuropathy, nausea, fatigue, neutropenia, and diarrhea.
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Eighteen patients with refractory Hodgkin's lymphoma, candidates for allogeneic stem cell transplantation and having received brentuximab vedotin before the allogeneic procedure, were analyzed. The 1-year overall survival was 100%, progression-free survival was 92.3%, and nonrelapse mortality was 0%. The incidence of acute graft-versus-host disease was 27.8% and chronic graft-versus-host disease was 56.3%. Brentuximab vedotin before reduced-intensity allogeneic stem cell transplantation did not adversely affect engraftment, GVHD, or survival and provided sufficient disease control to enable the transplantation procedure
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• Chen R, Palmer JM, Thomas SH, et al. Brentuximab vedotin enables successful reduced-intensity allogeneic hematopoietic cell transplantation in patients with relapsed or refractory Hodgkin lymphoma. Blood. 2012;119:6379-81. Eighteen patients with refractory Hodgkin's lymphoma, candidates for allogeneic stem cell transplantation and having received brentuximab vedotin before the allogeneic procedure, were analyzed. The 1-year overall survival was 100%, progression-free survival was 92.3%, and nonrelapse mortality was 0%. The incidence of acute graft-versus-host disease was 27.8% and chronic graft-versus-host disease was 56.3%. Brentuximab vedotin before reduced-intensity allogeneic stem cell transplantation did not adversely affect engraftment, GVHD, or survival and provided sufficient disease control to enable the transplantation procedure.
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A response-adjusted transplantation algorithm using allogeneic stem cell transplantation with a BEAM-Campath conditioning protocol for those patients deemed to be at high risk of failure of autologous stem cell transplantation because of a metabolically active disease after first-line salvage chemotherapy is analyzed
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