Anna Sureda, Sonja Genadieva-Stavrik, Ariane Boumendil, Herve Finel, Irma Khvedelidze, Sascha Dietricht, Peter Dreger, Olivier Hermine, Chara Kyriakou, Stephen Robinson, Norbert Schmitz, Harry Schouten, Alina Tanase, Silvia Montoto
Department of Hematology, Institut Catala d’Oncologia-Hospital Duran I Reynals, Barcelona, Spain, University hematology Clinic, University St. Cyril and Methodius, Medical Faculty - Skopje, Macedonia, EBMT Lymphoma Working Party, Paris, France, EBMT Lymphoma Working Party, Paris, France, EBMT Lymphoma Working Party, Paris, France, Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany, Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany, Department of Clinical Haematology, AP-HP, Necker Hospital, Paris, France, University College London Hospital, UK, Bone Marrow Transplant Unit, University Hospital Bristol, Bristol, UK, Department of Medicine, Hematology and Oncology, University Hospital Muenster, Muenster, Germany, Department of Hematology, Academische Ziekenhuis, Maastricht, Netherlands, Department of Stem Cell Transplantation, Fundeni Clinical Institute, Bucharest, Romania, Department of Haemato-Oncology, St Bartholomew‘s Hospital, Barts Health NHS Trust, London, UK
Background: Auto-HCT and allo-HCT represent well-accepted therapy modalities for patients with RR HL. Both transplant modalities have evolved over time and the recent advent of new drugs might have modified the indications and timing of HCT. We have analysed the transplant activity for patients with RR HL reported to the EBMT registry over the last three decades.
Methods: Patients were included if they had RR HL, > 18 years of age and had undergone an auto-HSCT as 1st HSCT or an allo-HSCT either as a 1st HSCT or after a prior auto-HSCT between Jan/1990 to Dec/2014.
Results: 13639 patients [11435 auto-HSCT and 2204 allo-HSCT (555 1st allo-HSCT and 1649 allo-HSCT after an auto-HSCT)] were registered in the EBMT database during the study period. With regards to auto-HCT (1990–1994 vs 2010–2014), there was a significant increase in median age at HSCT [31 yrs vs 35 yrs, p < 0.0001], time between diagnosis and HSCT became shorter [31 vs 23 mo, p < 0.0001], peripheral blood (PB) has become the universally used stem cell source [30% vs 98%, p < 0.0001] and total body irradiation has almost been abandoned [4% vs 1.7%, p < 0.0001]. 36-mo overall survival (OS) has improved over time [63% vs 79%, p < 0.0001] as well as non-relapse mortality (NRM) [12% vs 6%, p < 0.0001].
Allo-HSCT has been less commonly used as the 1st HSCT (comparison 1990–1994 vs 2010–2014)[88% vs 23%] whereas allo-HSCT after a first auto-HSCT has steadily increased [12% vs 77%, p < 0.0001]. Time between diagnosis and HSCT has decreased over time [36 mo vs 34 mo, p < 0.04]]. Performance status >80% at HSCT has improved [62% vs 94%, p < 0.0001], PB has become the universal source of stem cells [6% vs 84%, p < 0.0001], and there has been a more frequent use of reduced intensity conditioning protocols [0% vs 70%, p < 0.0001] as well as of matched unrelated donors and haplo donors [0% vs 48% and 0% vs 17%, respectively, p < 0.0001]. 36-month OS estimates have also improved [21% vs 61%, p < 0.001)] as well as those for progression free survival [15% vs 43%, p < 0.001] and NRM [58% vs 22%, p < 0.001].
Conclusions: Transplantation activity, the clinical pattern of patients undergoing this treatment and the characteristics of the procedure have significantly changed over the study period and results in terms of OS and NRM for both auto-HSCT and allo-HSCT are much better. The potential impact of new drugs on transplantation activity and outcomes it is difficult to ascertain at this point.