FLUDARABINE-MELPHALAN-CAMPATH FOLLOWED BY UNMANIPULATED PERIPHERAL-BLOOD HAEMATOPOIETIC STEM CELLS CAN STILL CURE LYMPHOMA.

Abstract

Background: The second decade of this millennium was characterized by a widespread availability of chimeric antigen receptor T-cell (CAR-T)therapies to treat relapsed and refractory lymphomas.

As expected, the role and indication of allogeneic haematopoietic stem cell transplant(allo-HSCT)in the management of lymphoma changed. Currently a not unneglectable proportion of patients will be considered candidate for an allo-HSCT and the debate of which transplant platform should be offered is still active.

Objectives:to report the outcome of patients affected with relapsed/refractory lymphoma and transplanted following reduced intensity conditioning at King’s College Hospital, London, between January 2009 and April2021. Methods: Conditioning was with fludarabine 150mg/m² and melphalan 140mg/m². The graft was unmanipulated G-CSF mobilized peripheral blood haematopoietic stem cells(PBSC). Graft-versus-host disease (GVHD) prophylaxis consisted of pre-transplant Campath at the total dose of 60 mg in unrelated donors and 30 mg in fully matched sibling donors, and ciclosporin.

Results: One year and five years OS were87% and79.9%, respectively and median OS was not reached. Cumulative incidence of relapse was 16%.Incidence of acute GVHD was 48%(only grade I/II); no cases of grade III/IV were diagnosed. Chronic GVHD occurred in 39% of patients. TRM was 12%, with no cases developed within day 100 and 18months after the procedure.

Conclusions:The outcomes of heavily pretreated lymphoma patients are favorable with median OS and survival not reached after a median of 49months. In conclusion, even if some lymphoma subgroups can’t be treated (yet) with advanced cellular therapies, this study confirms the role of allo-HSCT as a safe and curative strategy.