Haploidentical related donor compared to HLA-identical donor transplantation for chemosensitive Hodgkin lymphoma patients

L. Castagna, A. Busca, S. Bramanti, M. Raiola Anna, M. Malagola, F. Ciceri, W. Arcese, D. Vallisa, F. Patriarca, G. Specchia, R. Raimondi, R. Devillier, S. Furst, L. Giordano, B. Sarina, J. Mariotti, A. Olivieri, R. Bouabdallah, C. Carlo-Stella, A. RambaldiA. Santoro, P. Corradini, A. Bacigalupo, F. Bonifazi, D. Blaise

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Allogeneic stem cell transplantation from haploidentical donor using an unmanipulated graft and post-transplantation cyclophosphamide (PT-Cy) is growing. Haploidentical transplantation with PT-Cy showed a major activity in Hodgkin lymphoma (HL), reducing the relapse incidence. The most important predictive factor of survival and toxicity was disease status before transplantation, which was better in patients with well controlled disease. Methods: We included 198 HL in complete (CR) or partial remission (PR) before transplantation. Sixty-five patients were transplanted from haploidentical donor and 133 from a HLA identical donor (both sibling and unrelated donors). Survival analysis was defined according to the EBMT criteria. Survival curves were generated by using Kaplan-Meier method and differences between groups were compared by the log rank test or by the log rank test for trend when appropriated. Results: The PFS, OS, and RI were significantly better in patients in CR compared to PR (55% vs 29% p = 0.001, 74% vs 55% p = 0.03, 27% vs 55% p < 0.001, respectively). The 2-year PFS was significantly better for HAPLO than HLA-id (63% vs 37%, p = 0.03), without difference in OS. The 1-year NRM was not different. The 2-year relapse incidence (RI) was lower in the HAPLO group (24% vs 44%, p = 0.008). Patients in CR receiving haplo HSCT showed higher 2-year PFS and lower 2-year RI than those allografted with HLA-id donor (75% vs 47%, p < 0.001 and 11% vs 34%, p < 0.001, respectively). In multivariate analysis, donor type and disease status before transplantation were independent predictors of PFS as well as they predict the risk of relapse. Disease status at transplantation and age were independently associated to OS. Conclusions: Nonetheless this is a retrospective study, limiting the wide applicability of results, data from this analysis suggest that HLA mismatch can induce a strong graft versus lymphoma effect leading to an enhanced PFS. © 2020, The Author(s).
Original languageEnglish
Article number1140
JournalBMC Cancer
Volume20
Issue number1
DOIs
Publication statusPublished - 2020

Keywords

  • Haploidentical transplantation
  • Hodgkin lymphoma
  • Reduced intensity conditioning regimen
  • cyclophosphamide
  • cyclosporine
  • fludarabine
  • mycophenolate mofetil
  • tacrolimus
  • thiotepa
  • acute graft versus host disease
  • adult
  • age
  • aged
  • allogeneic stem cell transplantation
  • Article
  • cancer incidence
  • cancer mortality
  • cancer regression
  • cancer survival
  • chemosensitivity
  • chronic graft versus host disease
  • clinical outcome
  • cohort analysis
  • continuous infusion
  • controlled study
  • female
  • graft versus lymphoma effect
  • haploidentical donor
  • haploidentical transplantation
  • HLA system
  • Hodgkin disease
  • human
  • human cell
  • major clinical study
  • male
  • overall survival
  • prediction
  • progression free survival
  • reduced intensity conditioning
  • retrospective study
  • sibling
  • unrelated donor

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