Autologous HCT (autoHCT) salvages many patients (pts) with relapsed lymphomas but few relapsing after an autoHCT are cured. We determined feasibility of stem cell collection, engraftment kinetics, treatment-related mortality (TRM), progression free survival (PFS), and overall survival (OS) for a second autoHCT (HCT2) for lymphoma relapsing after prior HCT (HCT1). We studied 35 pts, 20 with HL and 15 with diffuse or follicular large cell and immunoblastic NHL, receiving a HCT2 for relapse between 1986 and 2003 and reported to the CIBMTR. Median (range) age at HCT2 was 36 yrs (16–61); 61% had a performance score less than 90. HCT2 was performed >1 year after HCT1 in 80%. Median (range) time from diagnosis to HCT1 was 20 mo (4–162 mo), from HCT1 to relapse, 17 mo (3–68 mo), and from relapse to HCT2, 5 mo (1–40 mo). 83% underwent a 2nd stem cell / marrow harvest prior to HCT2. Median time to ANC >0.5 x 109/L was 11d. CBV or BEAM were the conditioning regimens for HCT1 in 80% and for HCT2 in 60%. The best response to HCT2 was complete remission in 22 pts and partial remission in 5; 8 pts had either no response or progressive disease. At a median follow up of 92 mo (32–124 mo) after HCT2, 26 pts (74%) have died with 17 (65%) dying of relapsed lymphoma. Two (6%) patients developed therapy-related MDS. The probability of TRM at day 100 was 12% (95% CI, 3–25%). The 1, 3 and 5 yr probability of PFS were 45% (95% CI, 29–62%), 33% (95% CI, 18–50%) and 30% (95% CI, 15–46%), respectively. The 1, 3 and 5 yr probability of OS were 63% (95% CI, 46–78%), 34% (95% CI, 19–50%) and 31% (95% CI, 17–47%), respectively. There were no differences in outcomes between HL or NHL. Pts relapsing >6mo after HCT1 appeared to have better OS (fig 1 and 2). In summary, HCT2 is feasible in pts with lymphoma after relapsing an HCT1. Stem cells harvested prior to HCT2 resulted in rapid engraftment with a day 100 TRM (12%) lower than that reported for alloHCT in this setting. Relapse is the primary reason for failure, but approximately one-third of pts enjoy long-term disease free survival. HCT2 should be considered for young pts with relapsed HL or NHL post-HCT1 without alternative transplant options.

HCT1 (%)HCT2 (%)
Sensitive disease status pre-HCT 26 (79) 24 (75) 
Stem cell source   
BM 15 (43) 10 (29) 
PBSC 13 (37) 21 (60) 
Both 7 (20) 4 (11) 
Median days to platelet recovery ≥ 20 x 109 /L 17 (7–376) 20 (1–101) 
Stem cell harvest between HCT1 and HCT2  29 (83) 
Different conditioning regimen for HCT2  25 (74) 
Outcomes   
TRM @ 1 yr  21 (9–37) 
PFS @ 5yrs  30 (15–46) 
OS @ 5 yrs  31 (17–47) 
HCT1 (%)HCT2 (%)
Sensitive disease status pre-HCT 26 (79) 24 (75) 
Stem cell source   
BM 15 (43) 10 (29) 
PBSC 13 (37) 21 (60) 
Both 7 (20) 4 (11) 
Median days to platelet recovery ≥ 20 x 109 /L 17 (7–376) 20 (1–101) 
Stem cell harvest between HCT1 and HCT2  29 (83) 
Different conditioning regimen for HCT2  25 (74) 
Outcomes   
TRM @ 1 yr  21 (9–37) 
PFS @ 5yrs  30 (15–46) 
OS @ 5 yrs  31 (17–47) 
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Figure 1
Figure 1.
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Figure 2
Figure 2.
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Topics:
autologous hematopoietic stem cell transplant with purging, autologous hematopoietic stem cell transplant without purging, blood platelets, brachial plexus neuritis, complete remission, follow-up, hodgkin's disease, lymphoma, myelodysplastic syndrome, therapy related, partial response

Disclosure: No relevant conflicts of interest to declare.

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2006, The American Society of Hematology
2006
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