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Allogeneic Hematopoietic Cell Transplant Following Crizotinib Monotherapy for Relapsed/Refractory Anaplastic Large Cell Lymphoma

Year: 2017

Type: article

Abstract: Background: Anaplastic large cell lymphoma (ALCL) comprises 20-30% of pediatric non-Hodgkin's lymphoma cases with up to 90% exhibiting anaplastic lymphoma kinase (ALK) gene alterations. Cure rates approach 70-80% with conventional chemotherapy. Second remission for relapsed/refractory ALK+ ALCL is achievable with ALK inhibition via crizotinib (CRZ). We report on outcomes after allogeneic hematopoietic transplant (HST) for relapsed/refractory ALCL after CRZ. Methods: We performed a retrospective analysis of outcomes in children treated at Texas Children's Hospital for relapsed/refractory ALCL. All patients who receivedallogeneic HCT after CRZ were included. Data regarding engraftment status, acute transplant related complications and disease-free-survival were collected. Results: Five patients met the inclusion criteria. Post-HCT follow-up ranged from 1 month to 3.6 years. All 5 patients are alive and in remission. Four of 5 patients underwent reduced intensity conditioning. While all patients engrafted, 60% (n = 3) became mixed chimera requiring treatment with donor lymphocyte infusions (DLI). One of 5 patients developed grade 1 acute graft-vs-host disease (GVHD) of the skin. One of 5 patients developed chronic GVHD (after DLI). No acute organ toxicities were reported. See Table 1 for further details.Table 1#Upfront TherapyCRZ Duration (Months)HLAConditioningFollow-Up (Years)ComplicationsGVHD1CHOP (8 cycles)22.5MUDFlu/alemtuzumab/600TBI3Mixed Chimera (DLI x2)cGVHD2ALCL-992-3MRDFlu/ alemtuzumab/600TBI3.3Mixed Chimera (DLI x4)None3ALCL-997MUDFlu/ alemtuzumab/600TBI3.5NoneG1 aGVHD skin4NHL-BFM3MRDFlu/ alemtuzumab/600TBI3.6Mixed Chimera (DLI x 2)None5ALCL-993-4MUDCytarbine/cyclophos/alemtuzumab/1400TBI1 monthNoneNone Open table in a new tab Discussion: Allogeneic HST appears to be a safe and curative option for relapsed/refractory ALCL after remission re-induction with CRZ monotherapy. Due to the development of mixed chimerism in 60% of our patients, myeloablative conditioning may be preferable.

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.bbmt.2016.12.189