Lower graft-versus-host disease and relapse risk in post-transplant cyclophosphamide–based haploidentical versus matched sibling donor reduced-intensity conditioning transplant for Hodgkin lymphoma Journal Article


Authors: Ahmed, S.; Kanakry, J. A.; Ahn, K. W.; Litovich, C.; Abdel-Azim, H.; Aljurf, M.; Bacher, V. U.; Bejanyan, N.; Cohen, J. B.; Farooq, U.; Fuchs, E. J.; Bolaños-Meade, J.; Ghosh, N.; Herrera, A. F.; Hossain, N. M.; Inwards, D.; Kanate, A. S.; Martino, R.; Munshi, P. N.; Murthy, H.; Mussetti, A.; Nieto, Y.; Perales, M. A.; Romee, R.; Savani, B. N.; Seo, S.; Wirk, B.; Yared, J. A.; Sureda, A.; Fenske, T. S.; Hamadani, M.
Article Title: Lower graft-versus-host disease and relapse risk in post-transplant cyclophosphamide–based haploidentical versus matched sibling donor reduced-intensity conditioning transplant for Hodgkin lymphoma
Abstract: Classic Hodgkin lymphoma (cHL) patients with relapsed or refractory disease may benefit from allogeneic hematopoietic cell transplantation (allo-HCT), but many lack a matched sibling donor (MSD). Herein, we compare outcomes of 2 reduced-intensity conditioning (RIC) HCT platforms in cHL: T cell–replete related donor haploidentical (haplo) HCT with a post-transplant cyclophosphamide (PTCy)-based approach versus an MSD/calcineurin inhibitor (CNI)-based approach. The study included 596 adult patients who underwent a first RIC allo-HCT for cHL between 2008 and 2016 using either a haplo-PTCy (n = 139) or MSD/CNI-based (n = 457) approach. Overall survival (OS) was the primary endpoint. Secondary endpoints included acute graft-versus-host disease (aGVHD) and chronic GVHD (cGVHD), nonrelapse mortality (NRM), relapse/progression, and progression-free survival (PFS). On multivariate analysis, there was no significant difference between haplo/PTCy and MDS/CNI-based approaches in terms of OS (hazard ratio [HR], 1.07; 95% confidence interval [CI], .79 to 1.45; P = .66) or PFS (HR, .86; 95% CI, .68 to 1.10; P = .22). Haplo/PTCy was associated with a significantly higher risk of grades II to IV aGVHD (odds ratio [OR], 1.73, 95% CI, 1.16 to 2.59; P = .007), but the risk of grades III to IV aGVHD was not significantly different between the 2 cohorts (OR, .61; 95% CI, .29 to 1.27; P = .19). The haplo/PTCy platform provided a significant reduction in cGVHD risk (HR, .45; 95% CI, .32 to .64; P < .001), and a significant reduction in relapse risk (HR, .74; 95% CI, .56 to .97; P = .03). There was a statistically nonsignificant trend toward higher NRM with a haplo/PTCy approach (HR, 1.65; 95% CI, .99 to 2.77; P = .06). Haplo/PTCy-based approaches are associated with lower incidences of cGVHD and relapse, with PFS and OS outcomes comparable with MSD/CNI-based approaches. There was a leaning toward higher NRM with a haplo/PTCy-based platform. These data show that haplo/PTCy allo-HCT in cHL results in survival comparable with MSD/CNI-based allo-HCT. © 2019 American Society for Transplantation and Cellular Therapy
Keywords: hodgkin lymphoma; allogeneic transplantation; haploidentical transplantation; alternative donor
Journal Title: Biology of Blood and Marrow Transplantation
Volume: 25
Issue: 9
ISSN: 1083-8791
Publisher: Elsevier Inc.  
Date Published: 2019-09-01
Start Page: 1859
End Page: 1868
Language: English
DOI: 10.1016/j.bbmt.2019.05.025
PUBMED: 31132455
PROVIDER: scopus
PMCID: PMC6755039
DOI/URL:
Notes: Article -- Export Date: 1 October 2019 -- Source: Scopus
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  1. Miguel-Angel Perales
    584 Perales