Transplant Outcomes in Adults with HLH

Gooptu M, Kim HT, Jacobsen ED, et al. Favorable Outcomes Following Allogeneic Transplantation in Adults with Hemophagocytic Lymphohistiocytosis. Blood Advances. 2022; (doi: 10.1182/bloodadvances.2022007012).

New research suggests allogeneic hematopoietic stem-cell transplantation (HSCT) can negate the immune defect in hemophagocytic lymphohistiocytosis (HLH) when administered with a reduced intensity regimen involving early preconditioning using alemtuzumab. Researchers reviewed outcomes in a cohort of adult HLH patients transplanted starting in 2010. Patients were transplanted on a reduced intensity conditioning regimen involving early alemtuzumab infusion with standard infectious and graft-versus host disease (GVHD) prophylaxis. Overall survival (OS) was 75% at 3 years post-transplantation, while progression-free survival was 71%. The cumulative incidence (CI) of incidence of relapse at 3 years was 15%, with no isolated HLH relapses without malignancy relapse. The CI of non-relapse mortality at 3 years was 15%. Infectious complications and GVHD outcomes were similar to standard reduced intensity conditioning transplantation at the facility. Although it occurred frequently, mixed chimerism did not correspond with transplant outcomes.

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