Page 1802 - Hematology_ Basic Principles and Practice ( PDFDrive )

1606 Part X Transplantation

disease (TP53 deletion, 11q deletion) in the frontline setting and for (major disagreement) and recommend that this treatment should
those with CLL relapsing shortly after initial response (<2 years) therefore ideally be performed as part of a clinical trial.
irrespective of cytogenetics. The EBMT consensus group has recom-
mended allogeneic HCT as a reasonable treatment option for younger
patients with nonresponse, or relapse (within 12 months) after purine Multiple Myeloma
29
analogue therapy. Patients who relapse within 24 months after
having a response to purine analogue-based combinations and The NCCN guidelines consider allogeneic HCT with myeloablative
patients with TP53 abnormalities and those with Richter transforma- conditioning as an accepted option in the setting of a clinical trial,
tion requiring treatment are also considered candidates for transplant in those responding to primary therapy or with primary progressive
evaluation. The role and timing of allogeneic HCT in the era of disease. The guidelines did not recommend allogeneic HCT with
Bruton Tyrosine Kinase inhibitors will need to be redefined. nonmyeloablative conditioning alone as an option. RIC with alloge-
neic HCT following autologous HCT was considered a category 2A
recommendation (reflecting uniform NCCN consensus, based on
Diffuse Large B-Cell Lymphoma lower-level evidence including clinical experience, that the recom-
mendation is appropriate). Allogeneic HCT in the relapsed setting
The ASBMT panel recommends autologous transplantation as the after a prior autograft was considered a grade III recommendation
treatment of choice for relapsed or refractory chemosensitive diffuse reflecting major disagreement.
large B-cell lymphoma. Allogeneic HCT is a consideration in the
context of clinical trials and in select situations such as autologous
mobilization failure, persistent bone marrow disease, and after a failed REFERENCES
autologous transplant. 30
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Follicular Lymphoma 2. Bacigalupo A, Ballen K, Rizzo D, et al: Defining the intensity of con-
ditioning regimens: working definitions. Biol Blood Marrow Transplant
A systematic review by the ASBMT noted the lack of high-quality 15(12):1628–1633, 2009.
evidence regarding indications for allogeneic HCT in follicular 3. Sorror ML, Sandmaier BM, Storer BE, et al: Long-term outcomes
31
lymphoma. The consensus panel recommended autologous HCT among older patients following nonmyeloablative conditioning and
for relapsed disease or transformed follicular lymphoma. In the allogeneic hematopoietic cell transplantation for advanced hematologic
allogeneic setting, RIC was considered an acceptable alternative to malignancies. JAMA 306(17):1874–1883, 2011.
myeloablative regimens. The panel found no differences in outcomes 4. Kröger N, Brand R, Niederwieser D, et al: Reduced intensity vs.
between HLA identical sibling donors and matched unrelated donors. standard conditioning followed by allogeneic stem cell transplantation
Given the efficacy of rituximab-based salvage treatments and autolo- for patients with MDS or secondary AML: a prospective, randomized
gous HCT for follicular lymphoma, allogeneic HCT is generally used phase III study of the chronic malignancies working party of the EBMT
for patients who have failed, are likely to fail, or are unable to proceed (RICMAC-Trial). Blood 124(21):320, 2014.
to salvage autologous HCT. However, late application of allogeneic 5. Mielcarek M, Storer B, Martin PJ, et al: Long-term outcomes after
HCT may be less effective especially for chemotherapy refractory transplantation of HLA-identical related G-CSF-mobilized peripheral
disease. The NCCN guideline panel recommended autologous blood mononuclear cells versus bone marrow. Blood 119(11):2675–2678,
transplantation in second or third remission as a standard consolida- 2012.
32
tive strategy for relapsed follicular lymphoma. Allogeneic HCT was 6. Couban S, Simpson DR, Barnett MJ, et al: A randomized multicenter
a consideration for highly selected patients and those with histologic comparison of bone marrow and peripheral blood in recipients of
transformation to a higher grade (especially in the context of a clinical matched sibling allogeneic transplants for myeloid malignancies. Blood
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7. Anasetti C, Logan BR, Lee SJ, et al: Peripheral-blood stem cells versus
bone marrow from unrelated donors. N Engl J Med 367(16):1487–1496,
Mantle Cell Lymphoma 2012.
8. Eapen M, Logan BR, Horowitz MM, et al: Bone marrow or peripheral
NCCN guidelines recommend autologous transplantation as an blood for reduced-intensity conditioning unrelated donor transplanta-
32
adjunct to initial therapy in eligible patients. Expert opinion is that tion. J Clin Oncol 2014.
allogeneic HCT has a limited role as upfront consolidation in 9. Gragert L, Eapen M, Williams E, et al: HLA match likelihoods for
chemotherapy-sensitive disease. Given the poor prognosis of recur- hematopoietic stem-cell grafts in the U.S. registry. N Engl J Med
rent mantle cell lymphoma and the curative potential of allogeneic 371(4):339–348, 2014.
HCT, it is a reasonable option for patients relapsing after upfront 10. Laughlin MJ, Eapen M, Rubinstein P, et al: Outcomes after transplanta-
autologous transplantation or those with chemotherapy refractory tion of cord blood or bone marrow from unrelated donors in adults with
disease. leukemia. N Engl J Med 351(22):2265–2275, 2004.
11. Wagner JE, Jr, Eapen M, Carter S, et al: One-unit versus two-unit
cord-blood transplantation for hematologic cancers. N Engl J Med
T-Cell Lymphoma 371(18):1685–1694, 2014.
12. Bashey A, Zhang X, Sizemore CA, et al: T-cell-replete HLA-haploidentical
NCCN guidelines recommend consideration of allogeneic HCT in hematopoietic transplantation for hematologic malignancies using post-
32
the relapsed or refractory setting in T-cell lymphoma. In cutaneous transplantation cyclophosphamide results in outcomes equivalent to
T-cell lymphoma, allogeneic HCT is considered in the setting of those of contemporaneous HLA-matched related and unrelated donor
progressive or refractory stage IIB–IV disease after failure of biologic transplantation. J Clin Oncol 31(10):1310–1316, 2013.
agents and at least one line of chemotherapy. 13. Brunstein CG, Fuchs EJ, Carter SL, et al: Alternative donor transplanta-
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trials using partially HLA-mismatched related bone marrow or unrelated
Hodgkin Lymphoma double umbilical cord blood grafts. Blood 118(2):282–288, 2011.
13a. Barnes DW, Loutit JF, Micklem HS: “Secondary disease” of radia-
NCCN guidelines currently consider allogeneic HCT in progressive tion chimeras: a syndrome due to lymphoid aplasia. Ann N Y Acad Sci
or relapsed Hodgkin lymphoma as a category 3 recommendation 99:374–385, 1962.