Nonmyeloablative alternative donor transplantation for Hodgkin and non-Hodgkin lymphoma: From the LWP-EBMT, Eurocord, and CIBMTR: Journal of Clinical Oncology

G. Fatobene, V. Rocha, A. St. Martin, M. Hamadani, S. Robinson, A. Bashey, A. Boumendil, C. Brunstein, L. Castagna, A. Dominietto, H. Finel, Y. Chalandon, C. Kenzey, M. Kharfan-Dabaja, H. Labussière-Wallet, J.M. Moraleda, R. Pastano, M.-A. Perales, H.R. El Ayoubi, A. RuggeriA. Sureda, F. Volt, I. Yakoub-Agha, M.-J. Zhang, E. Gluckman, S. Montoto, M. Eapen

Research output: Contribution to journalArticlepeer-review

Abstract

PURPOSE To compare the outcomes of patients with Hodgkin or non-Hodgkin lymphoma undergoing non-myeloablative haploidentical or unrelated cord blood (UCB) hematopoietic cell transplantation. PATIENTS AND METHODS We retrospectively studied 740 patients with Hodgkin lymphoma (n = 283, 38%) and non-Hodgkin lymphoma (n = 457, 62%) age 18-75 years who received transplantations from 2009 to 2016. Data were reported to the Lymphoma Working Party of the European Society for Blood and Marrow Transplantation, Eurocord, or Center for International Blood and Marrow Transplant Research. Of the 526 patients who received haploidentical transplantation, 68% received bone marrow and 32% received peripheral blood. All patients received a uniform transplantation conditioning regimen (2 Gy of total-body irradiation, cyclophosphamide, and fludarabine) and graft-versus-host disease prophylaxis (calcineurin inhibitor and mycophenolate). In addition, patients who received a haploidentical transplantation received posttransplantation cyclophosphamide. RESULTS Compared with haploidentical bone marrow and peripheral-blood transplantations and adjusted for age, lymphoma subtype, and disease status, survival was lower after UCB transplantation (hazard ratio [HR], 1.55; P = .001; and HR, 1.59; P = .005, respectively). Similarly, progression-free survival was lower after UCB transplantations compared with haploidentical bone marrow and peripheral-blood transplantations (HR, 1.44; P = .002; and HR, 1.86; P, .0001), respectively. The 4-year overall and progression-free survival rates after UCB transplantation were 49% and 36%, respectively, compared with 58% and 46% after haploidentical bone marrow transplantation and 59% and 52% after peripheral-blood transplantation, respectively. Lower survival was attributed to higher transplantation-related mortality after UCB transplantation compared with haploidentical bone marrow and peripheral-blood transplantation (HR, 1.91; P = .0001; and HR, 2.27; P = .0002, respectively). CONCLUSION When considering HLA-mismatched transplantation for Hodgkin or non-Hodgkin lymphoma, the data support haploidentical related donor transplantation over UCB transplantation. © 2020 by American Society of Clinical Oncology
Original languageEnglish
Pages (from-to)1518-1526
Number of pages9
JournalJ. Clin. Oncol.
Volume38
Issue number14
DOIs
Publication statusPublished - 2020

Keywords

  • calcineurin inhibitor
  • cyclophosphamide
  • fludarabine
  • mycophenolic acid
  • acute graft versus host disease
  • adult
  • aged
  • Article
  • bone marrow transplantation
  • cancer mortality
  • chronic graft versus host disease
  • controlled study
  • female
  • haploidentical transplantation
  • hematopoietic stem cell transplantation
  • Hodgkin disease
  • human
  • longitudinal study
  • major clinical study
  • male
  • middle aged
  • nonhodgkin lymphoma
  • nonmyeloablative stem cell transplantation
  • overall survival
  • priority journal
  • progression free survival
  • retrospective study
  • transplantation conditioning
  • whole body radiation

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