Real-World Outcomes of Allogeneic Stem Cell Transplantation in Relapsed Hodgkin Lymphoma: A Single-Center Experience from India.

Abstract

Background: Relapsed Hodgkin lymphoma (HL) after autologous stem cell transplantation (auto-HSCT) remains a major therapeutic challenge with few curative options. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) may provide durable disease control, yet outcome data from tertiary-care centres in India are limited.

Objective: To evaluate real-world outcomes of allo-HSCT in patients with chemotherapy-sensitive relapsed HL at a tertiary care centre in North India.

Methods: This retrospective study included patients with chemotherapy-sensitive relapsed HL who underwent allo-HSCT at the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, between January 2017 and December 2023. Clinical data including baseline characteristics, transplant parameters, complications, and survival outcomes were reviewed. Descriptive statistics were used, and overall survival (OS) was estimated using the Kaplan-Meier method.

Results: Five patients (median age 18 years; range 14-30) with chemotherapy-sensitive relapse following auto-HSCT underwent allogeneic transplantation in complete remission (CR) after salvage therapy. Donors included haploidentical (n=3), matched unrelated (n=1), and matched sibling (n=1). Four patients received reduced-intensity conditioning; one received myeloablative conditioning. Graft-versus-host disease (GVHD) prophylaxis included post-transplant cyclophosphamide (PT-Cy) in four patients. Neutrophil and platelet engraftment occurred at median 15 and 16 days, respectively. All patients developed bacterial infections; one succumbed to Gram-negative sepsis. Acute grade III GVHD occurred in one patient, and two developed limited chronic GVHD. At a median follow-up of 44 months, four patients remained in continuous remission, with a 3-year OS of 80%.

Conclusion: In Indian patients with chemotherapy-sensitive relapsed HL, allo-HSCT using reduced-intensity and reduced toxicity conditioning regimens and post-transplant cyclophosphamide-based regimens has proven feasible and effective, yielding encouraging survival outcomes within routine clinical practice.