Published on February 20, 2020
- When someone relapses after an autologous stem transplant, the only type of curative treatment right now is an allogeneic stem cell transplant.
- Autologous means your own stem cells, and allogeneic means using someone else's stem cells and their immune system to fight your lymphoma.
Hodgkin lymphoma expert Dr. Sairah Ahmed, from The University of Texas MD Anderson Cancer Center, explains what a reduced-intensity conditioning (RIC) regimen is and how it can prepare patients for an allogeneic stem cell transplant with less toxicity.
Watch as Dr. Ahmed also discusses ongoing clinical trials looking at the use of CAR-T cells for relapsed Hodgkin lymphoma.
Transcript | Improving Transplant Conditioning Regimens
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There’s something called RIC that some patients have asked about. I know it has something to do with preparing for an autologous transplant. Can you kind of explain what that is and how it’s relevant for patients?
Right. So, once someone relapses after an autologous transplant, right now the only curative type of treatment is an allogeneic stem cell transplant. The difference is autologous means your own cells, allogeneic is somebody else’s cells. When you get stem cells from someone else, you’re basically getting their immune system to fight your lymphoma. And so, the problem with that is it has its own side effects, including graft-versus-host disease - that new immune system coming in not recognizing the recipient or the donor, but coming in and so the interaction from those donor cells and recipient cells can cause skin rashes, diarrhea, liver dysfunction and a host of other problems.
And so, that’s one of the side effects that we look at, the other is infection, but a big problem has always been as people are getting the conditioning chemotherapy that relates to toxicity. And when we use what are called myeloablative doses of conditioning, in Hodgkin lymphoma we found that between 20 and 30 percent of patients were dying within the first year because of complications associated with the actual transplant, not because of the lymphoma coming back. So, RIC means reduced intensity conditioning and what that is, is lower doses of the chemotherapy that is used to help condition the body for those new cells.
There are a number of different reduced intensity conditioning regimens, they’re also called non-myeloablative regimens. And so, for Hodgkin lymphoma that’s the standard of care and allogeneic transplant when it’s going to be done should be done with a reduced intensity conditioning except for a few exceptions.
There are some interesting clinical trials using CD30 CAR-T cells and so, that may in the future become an option for patients who are not eligible for allogeneic transplant. If you look at the diffuse large B-cell population, CD19 CAR-T cells have actually become one of the steps that you do before you go to an allogeneic transplant, because potentially you can cure the disease, make it go away not come back without going through the toxicity and side effects of an allogeneic transplant.
We’re not there yet in terms of Hodgkin lymphoma, but there are a number of trials that will be opening in the next probably three to four months in different centers all around the country using CD30 CAR-T cells for relapsed Hodgkin lymphoma.
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