Long-term remission of primary refractory ALK-positive anaplastic large cell lymphoma after allogeneic hematopoietic stem cell transplantation (2023)

FAQs

What is the success rate of autologous stem cell transplant for lymphoma patients? ›

Overall, the prognosis is excellent, as 90% of patients with early stage disease and 70–80% of patients with advanced stage disease will be cured by frontline treatment.

Recurrence of Hodgkin lymphoma (HL) occurs in about 50% of patients after autologous stem cell transplantation (ASCT), usually within the first year, and represents a significant therapeutic challenge.

Reported survival rates 3–5 years after autoHCT for classical Hodgkin lymphoma (cHL) and diffuse large B-cell lymphoma (DLBCL) range between 40 and 70%. Treatment failure is most commonly due to relapse or progression of the underlying disease, which primarily occurs within the first two years after autoHCT.

Approximately 40% to 65% of patients with systemic ALCL develop recurrent disease after first-line therapy.

It usually takes 3 to 12 months for your immune system to recover from your transplant. The first year after transplant is like your first year of life as a newborn baby. During this time, you're at risk for infection. Your transplant team will check your blood cell counts to see how well your immune system is working.

Cure models support the potential for cure, ranging from 6.3% to 31.3%, depending on the year of treatment, with 10.0% to 18.6% of patients achieving their normal life expectancy across multiple periods.

Most relapses of Hodgkin lymphoma or high-grade non-Hodgkin lymphoma happen within the first 2 years after treatment. As time goes on, relapse generally becomes less likely.

Overall survival is approximately 80% to 90%. A subset of these patients has refractory disease or experience disease relapse. Conventional salvage therapies and autologous stem-cell transplantation is usually considered the standard of care for these patients.

Some people with cutaneous T-cell lymphoma may experience a remission with allogeneic stem cell transplantation, meaning the signs and symptoms of the condition go away. Remission can last for several years.

Conclusion. Patients who have survived for at least 5 years after hematopoietic cell transplantation without recurrence of the original disease have a high probability of surviving for an additional 15 years, but life expectancy is not fully restored.

What cancers are common after stem cell transplant? ›

Leukemia or myelodysplastic syndrome (MDS) occasionally occurs in patients who were transplanted with their own stem cells (autologous transplant). The risk is highest among patients who: received certain types of chemotherapy before or during transplant, such as cytoxan or etoposide.

The standard treatment for relapsed and primary refractory HL is salvage chemotherapy followed by high-dose chemotherapy and autologous stem cell transplantation (ASCT), which has shown a 5-year progression-free survival rate of ∼50%–60%.

Primary cutaneous ALCL often returns within five years of treatment. You may need additional surgery and radiation therapy if it comes back.

Cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP)/CHOP-like regimen remains the standard treatment of ALK-positive ALCL, with a 5-year overall survival (OS) rate of 70-90%.

Many people with low-grade non-Hodgkin lymphoma have full or partial remission that lasts for many months or even years after treatment for lymphoma. Most of these people have different treatments over time. This is because it usually comes back (relapses) or worsens at some point, and then needs further treatment.

In the 2-year survivors, disease-free survival was 64% (60-68%) and overall survival was 74% (71-78%) at ten years; results were better in younger individuals and in women. Excess mortality was 14% (8-21%) in patients aged <45 years and 33% (13-53%) in patients aged ≥65 years.

However, it's important to know that while a stem cell transplant can cause multiple myeloma to go into remission for a period of time, most people eventually relapse. That means that the cancer comes back. A relapse can happen any time after a stem cell transplant. For many people, it may be years.

Second transplant

This could be an option if you've had graft failure or rejection, or for some people who have relapsed. In some cases, the same donor might be used as your first transplant, but the transplant will be done with different chemotherapy drugs.

The median age at allo-SCT was 32.76 years and 42 patients (41.6%) died. The 5-year OS and disease-free survival (DFS) was 56% (95%CI: 51-61%) and 52% (95%CI: 57-47%), respectively.

More than 80% of people who had aplastic anemia are cured after allogeneic stem cell transplantation.

What is the mortality of allogeneic stem cell transplant? ›

Transplantation-related mortality (TRM) is a major obstacle in allogeneic hematopoietic cell transplantation (allo-HCT). Approximately 60–80% of TRM occurs early, within 100 days of transplantation.

The term “relapsed” refers to disease that reappears or grows again after a period of remission. The term “refractory” is used to describe when the lymphoma does not respond to treatment (meaning that the cancer cells continue to grow) or when the response to treatment does not last very long.

More specifically half the recurrences happen within 2 years of primary treatment and up to 90% occur before 5 years. Occurrence of a relapse after 10 years is rare and after 15 years the risk of developing lymphoma is same as its risk in the normal population.

Since 2019, the following four non-CAR T cell treatments have been approved by the FDA for patients with relapsed/refractory DLBCL (Table 1): polatuzumab vedotin in combination with BR (BR–pola) (June 2019), selinexor (June 2020), tafasitamab plus lenalidomide (July 2020), and loncastuximab tesirine (April 2021).

Relapsed disease means a cancer has come back. Refractory disease means a cancer has stopped responding to treatment.

Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma. Although 5-year survival rates in the first-line setting range from 60% to 70%, up to 50% of patients become refractory to or relapse after treatment.

In the first month or so after an allogeneic stem cell transplant, you are at highest risk of developing bacterial infections, such as bloodstream infections, pneumonia, digestive system infections or skin infections. In the next few months, you are most at risk of developing viral infections.

BMT, also known as a bone marrow transplant or blood stem cell transplant, replaces the immature (blood-forming cells) cells that grow into unhealthy lymphocytes with healthy ones. For some people transplant can cure the NHL.

It aims to kill any leftover lymphoma cells in your body and to reduce or destroy the stem cells in your bone marrow. This makes room for the new, healthy stem cells in your bone marrow. If you are having a donor (allogeneic) stem cell transplant, it also helps stop your immune system rejecting the donor cells.

What is the life expectancy in patients surviving more than 5 years after hematopoietic cell transplantation? ›

CONCLUSION Patients who have survived for at least 5 years after hematopoietic cell transplantation without recurrence of the original disease have a high probability of surviving for an additional 15 years, but life expectancy is not fully restored.

People have more probability of surviving for another 15 years after a bone marrow transplant, who's been able to survive for at least 5 years after hematopoietic cell transplant without any signs and symptoms of relapse of the original disease. However, a normal life expectancy is not completely achieved.

Infections, toxicity, and (after allogeneic HSCT only), graft-vs. -host disease (GVHD) are the main causes of death.

CMV is a major cause of morbidity and mortality in BMT transplant recipients. The virus, which latently infects many different types of cells, including hematopoietic cells, epithelial cells, and endothelial cells, may already be present in the recipient or acquired at or subsequent to transplant.

Common Cancers after Transplantation. Although the risk of overall cancer development is high after transplantation, the risks of certain cancer types are much higher than others. Here, we discuss the three most common cancer types: renal cell carcinoma, skin cancer, and PTLD.

Graft-versus-host disease (GVHD).

If you receive stem cells from a donor, the transplanted stem cells may attack your body. This is known as graft-versus-host disease, which can increase your risk for fungal infection.

Mayo Clinic's bone marrow (stem cell) transplant team is recognized internationally for its expertise in comprehensive specialty treatment for people with blood and bone marrow diseases. Mayo Clinic is one of the largest providers of bone marrow transplants in the United States.

The upper age limit of alloSCT for acute myeloid leukemia (AML), used as a curative modality, has steadily increased over the past 4 decades from 40 to 45 to 70 to 75 years.

The overall prognosis is better than other peripheral T-cell lymphomas. ALCL (ALK-positive) has a better prognosis than ALCL (ALK-negative) with a 5-year overall-all (OS) of 80% compared to 48%. International Prognostic Index (IPI), is a useful prognostic tool in ALCL (ALK-positive).

Can anaplastic lymphoma be cured? ›

When the lymphoma is only in one area of the body (stage 1 or 2) it is called "localized." When it is more extensive (stage 3 or 4) it is called "advanced." With current therapies, more than 70% of children with anaplastic large cell lymphoma are cured of the disease.

Brentuximab vedotin (Adcetris) is a targeted therapy drug that targets CD30. It may be used along with chemotherapy to treat systemic ALCL that expresses CD30.

Follicular lymphoma

almost 90 in 100 people (almost 90%) survive their cancer for 5 years or more after diagnosis.

It is important to note that everyone is different, and many people can live much longer than these estimates suggest. Overall, the 5-year survival rate for stage 4 Hodgkin lymphoma is 65 percent . The following risk factors affect a person's prognosis and can make lymphoma more severe: presence of B symptoms.

Yes. The more advanced your cancer is, the more challenging your odds may become. However, stage 4 lymphoma is treatable and many people live for many years after getting this diagnosis.

In general, the goal of treatment is to destroy as many lymphoma cells as possible and to induce a complete remission. Complete remission means that all evidence of disease is eliminated. Patients who go into remission are sometimes cured of their disease.

Most people with lymphoma do not need a stem cell transplant. Autologous stem cell transplants are used in certain circumstances with the aim of curing your lymphoma (especially Hodgkin lymphoma or high-grade non-Hodgkin lymphoma) or making your remission from lymphoma last longer than would otherwise be possible.

Stem cell or bone marrow transplant is a way of giving very high dose chemotherapy. This treatment aims to cure some types of cancer, including Hodgkin lymphoma.

Background. Autologous stem-cell transplantation (ASCT) is part of standard therapy for lymphoma. Although ASCT appears to improve survival in several lymphomas [1,2,3,4,5,6,7], it is associated with a significant treatment-related mortality (TRM; 2.5% to 11%) [6, 8,9,10]. Selecting the right patient is essential.

The cost of a stem cell transplant can vary depending on the type of treatment needed, ranging from $15,000 to $75,000. According to a 2022 poll, treatments cost between $10,000 and $40,000, while a Twitter poll reported that patients could expect to spend from under $5,000 to over $50,000.

Does insurance cover stem cell transplant for lymphoma? ›

Insurance policies will not cover treatments they consider experimental. By experimental, they mean procedures or treatments that raise concerns over harmful effects and/or unproven benefits. Insurance companies consider most instances of stem cell therapy to be experimental and will not cover the costs.

Blastic NK cell lymphoma

This very rare type of T cell lymphoma only affects a few people each year. It usually affects adults. Blastic NK cell lymphoma tends to grow very quickly and can be difficult to treat. It can start almost anywhere in the body.

Lymphoma is often curable, especially in its initial stages.

More than 80 percent of all patients diagnosed with Hodgkin lymphoma can be cured by current treatment approaches.

Allogeneic hematopoietic cell transplantation (HCT) is curative but is associated with life-threatening complications. Most deaths occur within the first 2 years after transplantation.

Research led by UAB's Institute for Cancer Outcomes and Survivorship and director Smita Bhatia, M.D., MPH (above) finds that patients who received autologous blood or marrow transplantation (using their own cells) over the past three decades lived on average seven years fewer than peers.

The median age at allo-SCT was 32.76 years and 42 patients (41.6%) died. The 5-year OS and disease-free survival (DFS) was 56% (95%CI: 51-61%) and 52% (95%CI: 57-47%), respectively.

Overall survival at 1 year after allo-SCT was 54.8% from 1980 through 1989, 57.6% from 1990 through 1999, 67.5% % from 2000 through 2009, and 72.1% from 2010 through 2016 (Figure 1C).