ASH 2011: Major Advances in Allogeneic Stem Cell Transplant Offer New Hope For Patients with Hematologic Malignancies

By Koen van Besien, MD, PhD

Allogeneic transplant can be curative for patients with lymphoma and is often effective in difficult situations where other treatments have failed. Unfortunately very few of us have suitable sibling donors and in a multi-ethnic society such as the US, finding HLA-identical donors in the transplant registry can also represent a challenge.  Several studies presented at the Annual Society of Hematology meeting offer evidence of rapid progress and increased success in the field of mismatched transplantation.  Dr. Symons from John’s Hopkins used mismatched related donors  ( also called haplo-identical donors i.e relatives who are partially HLA-identical) and with a novel chemotherapy regimen and  GVHD prophylaxis reported a low risk for graft vs host disease and excellent outcomes in patients with very high risk disease. Using similar technology even better results were reported by Dr. Bashey from Atlanta. He reported that the outcomes of such haplo-transplant were similar to those of transplants from HLA-identical siblings.  We used a slightly different approach and combined a haplo-identical transplant with an umbilical cord blood graft. In this procedure, the umbilical cord blood graft tends to assure long term hematopoiesis and may provide a more robust immune system with very little chronic graft vs host disease. We presented data on 51 patients with hematologic malignancies and the group from NIH used a similar approach to treat 10 pts with aplastic anemia. Both groups showed excellent rates of recovery and a high percentage of patients achieving prolonged remissions.  Dr. van Rood showed that the choice of umbilical cord graft may minimize the risk for disease recurrence.  It is too early to know which of these approaches, haplo or haplo-cord transplantation will ultimately become widely accepted, but the field is moving rapidly and options for patients who lack a sibling donor are rapidly improving.

Allogeneic transplantation for Hodgkin’s lymphoma

Though most patients with Hodgkin’s Lymphoma (HL) are cured with their initial treatment, a small percentage of them fail to achieve remission or relapse after initial treatment. Such patients usually receive a salvage chemotherapy regimen followed by autologous stem cell transplantation. However, only half of those undergoing autologous transplant are cured, and that percentage is even lower for those with incomplete responses to salvage. Using an innovative approach, Continue reading “ASH 2011: Major Advances in Allogeneic Stem Cell Transplant Offer New Hope For Patients with Hematologic Malignancies”

Lymphoma in the News: Cigarette Smoking Associated with Hodgkin Lymphoma

By Peter Martin, MD

More bad news for smokers: A recent study published in the Journal of Clinical Oncology reports an association between cigarette smoking and Hodgkin lymphoma. The investigators evaluated 17 large cohort studies, involving over one million individuals and 285 cases of Hodgkin lymphoma. They found that current smokers had a 39% higher risk developing Hodgkin lymphoma. Among men, individuals older than 30 or 40 years old, those that smoked more than 20 cigarettes per day, and those that smoked for more than 20 years, the risk was even higher.

The good news is that former smokers did not have an increased risk of Hodgkin lymphoma, but this may have been due to inconsistencies regarding the way “former smoker” was defined in the cohort studies.

The authors conclude, “The health implications of tobacco smoke are vast, having an impact on almost every organ system. Smoking cessation will have a positive impact on public health and should be advised globally.”

 

FDA Approves Brentuximab for Hodgkin Lymphoma and Anaplastic Large Cell Lymphoma

By Rebecca Elstrom, MD

The FDA granted accelerated approval last week to brentuximab vedotin for use in patients with Hodgkin lymphoma (HL) which has relapsed after 2 prior therapies, and patients with anaplastic large T cell lymphoma (ALCL) which has relapsed after one prior treatment. Weill Cornell Medical College participated in the studies that led to the approval.

Brentuximab vedotin is an antibody-drug conjugate (ADC); that is, a chemotherapy drug which has been attached to a monoclonal antibody in order to deliver the drug more specifically to target cells. In this case, the ADC targets CD30, a protein on the surface of the malignant HL cells and ALCL. Two phase 2 clinical studies were recently completed evaluating activity of brentuximab vedotin in HL patients who had had recurrence following autologous stem cell transplant and in ALCL patients that had relapsed after prior therapy. Response in both patient groups was striking. In HL, 73% of patients responded to treatment, with 32% achieving complete remission.  In ALCL, 86% of patients responded, with 57% achieving complete remission.

Major side effects of brentuximab vedotin in both groups of patients consisted of peripheral neuropathy, decreased blood counts, fatigue, nausea, rash and fever.

While long term results are still under investigation, initial response rates indicate that this drug represents an important new tool in the care of patients without other standard treatment options. Further studies are ongoing investigating how best to incorporate brentuximab vedotin into the routine care of patients with these lymphomas.