Outcomes of Advanced Hodgkin Lymphoma after Umbilical Cord Blood Transplantation: A Eurocord and EBMT Lymphoma and Cellular Therapy & Immunobiology Working Party Study

Annalisa Paviglianiti, Karina Tozatto Maio, Vanderson Rocha, Eve Gehlkopf, Noel Milpied, Albert Esquirol, Patrice Chevallier, Didier Blaise, Anne-Claire Gac, Véronique Leblond, Jean Yves Cahn, Manuel Abecasis, Tsila Zuckerman, Harry Schouten, Gunhan Gurman, Marie Thérèse Rubio, Yves Beguin, Lucia Lopez Corral, Arnon Nagler, John A SnowdenYener Koc, Nicola Mordini, Francesca Bonifazi, Fernanda Volt, Chantal Kenzey, Stephen Paul Robinson, Silvia Montoto, Eliane Gluckman, Annalisa Ruggeri

Research output: Contribution to journalArticle

Abstract

Allogeneic stem cell transplantation is an alternative for patients with relapsed or refractory Hodgkin lymphoma (HL), but only limited data on unrelated umbilical cord blood transplantation (UCBT) are available. We analyzed 131 adults with HL who underwent UCBT in European Society for Blood and Marrow Transplantation centers from 2003 to 2015. Disease status at UCBT was complete remission (CR) in 59 patients (47%), and almost all patients had received a previous autologous stem cell transplantation. The 4-year progression-free survival (PFS) and overall survival (OS) were 26% (95% confidence interval [CI], 19% to 34%) and 46% (95% CI, 37% to 55%), respectively. Relapse incidence was 44% (95% CI, 36% to 54%), and nonrelapse mortality (NRM) was 31% (95% CI, 23% to 40%) at 4 years. In multivariate analysis refractory/relapsed disease status at UCBT was associated with increased relapse incidence (hazard ratio [HR], 3.14 [95% CI, 1.41 to 7.00], P = .005) and NRM (HR, 3.61 [95% CI, 1.58 to 8.27], P = .002) and lower PFS (HR, 3.45 [95% CI, 1.95 to 6.10], P < .001) and OS (HR, 3.10 [95% CI, 1.60 to 5.99], P = .001). Conditioning regimen with cyclophosphamide + fludarabine + 2 Gy total body irradiation (Cy+Flu+2GyTBI) was associated with decreased risk of NRM (HR, .26 [95% CI, .10 to .64], P = .004). Moreover, Cy+Flu+2GyTBI conditioning regimen was associated with a better OS (HR, .25 [95% CI, .12 to .50], P < .001) and PFS (HR, .51 [95% CI, .27 to .96], P = .04). UCBT is feasible in heavily pretreated patients with HL. The reduced-intensity conditioning regimen with Cy+Flu+2GyTBI is associated with a better OS and NRM. However, outcomes are poor in patients not in CR at UCBT.

Original languageEnglish
Pages (from-to)2265-2270
Number of pages6
JournalBiology of Blood and Marrow Transplantation
Volume24
Issue number11
DOIs
Publication statusPublished - Nov 2018
Externally publishedYes

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    Paviglianiti, A., Tozatto Maio, K., Rocha, V., Gehlkopf, E., Milpied, N., Esquirol, A., Chevallier, P., Blaise, D., Gac, A-C., Leblond, V., Cahn, J. Y., Abecasis, M., Zuckerman, T., Schouten, H., Gurman, G., Rubio, M. T., Beguin, Y., Corral, L. L., Nagler, A., ... Ruggeri, A. (2018). Outcomes of Advanced Hodgkin Lymphoma after Umbilical Cord Blood Transplantation: A Eurocord and EBMT Lymphoma and Cellular Therapy & Immunobiology Working Party Study. Biology of Blood and Marrow Transplantation, 24(11), 2265-2270. https://doi.org/10.1016/j.bbmt.2018.07.019