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Blood. 2016 Feb 18;127(7):938-47. doi: 10.1182/blood-2015-09-671834. Epub 2015 Dec 15.

Reduced-intensity transplantation for lymphomas using haploidentical related donors vs HLA-matched unrelated donors.

Author information

1
Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, WV;
2
S.C. Ematologia e Trapianto di Midollo Osseo, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan, Italy;
3
Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL;
4
Center for International Blood and Marrow Transplant Research, Department of Medicine and Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI;
5
Center for International Blood and Marrow Transplant Research, Department of Medicine and.
6
Division of Hematology/Oncology, Department of Medicine, Emily Couric Clinical Cancer Center, Charlottesville, VA;
7
Division of Hematology/Oncology, Medical University of South Carolina, Charleston, SC;
8
Department of Hematology/Oncology, Froedtert Memorial Lutheran Hospital, Milwaukee, WI;
9
South Texas Veterans Health Care System and University of Texas Health Science Center San Antonio, San Antonio, TX;
10
Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, United Kingdom;
11
Blood and Marrow Transplantation, Division of Hematology and Oncology, University of Kansas Medical Center, Kansas City, KS;
12
Department of Haematology, Prince of Wales Hospital, Randwick, NSW, Australia;
13
Department for Stem Cell Transplantation, University Cancer Center, Hamburg, Germany;
14
Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH;
15
Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden;
16
Adult Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY;
17
Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, CA;
18
Division of Hematology/Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, NC;
19
Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL;
20
The International Center for Cell Therapy & Cancer Immunotherapy, Tel Aviv, Israel;
21
Section of Hematology/Oncology, The University of Chicago, Chicago, IL;
22
Servei d'Hematologia, Institut Catala d'Oncologia, Hospital Duran I Reynals, Barcelona, Spain;
23
Blood & Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Cancer Center, University of Maryland, Baltimore, MD;
24
Department of Hematology, MD Anderson Cancer Center, Houston, TX;
25
Department of Medical Oncology/Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA;
26
Department of Hematology/Oncology, Fred Hutchinson Cancer Research Center, Seattle, WA; and.
27
Division of Hematologic Malignancies, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD.

Abstract

We evaluated 917 adult lymphoma patients who received haploidentical (n = 185) or HLA-matched unrelated donor (URD) transplantation either with (n = 241) or without antithymocyte globulin (ATG; n = 491) following reduced-intensity conditioning regimens. Haploidentical recipients received posttransplant cyclophosphamide-based graft-versus-host disease (GVHD) prophylaxis, whereas URD recipients received calcineurin inhibitor-based prophylaxis. Median follow-up of survivors was 3 years. The 100-day cumulative incidence of grade III-IV acute GVHD on univariate analysis was 8%, 12%, and 17% in the haploidentical, URD without ATG, and URD with ATG groups, respectively (P = .44). Corresponding 1-year rates of chronic GVHD on univariate analysis were 13%, 51%, and 33%, respectively (P < .001). On multivariate analysis, grade III-IV acute GVHD was higher in URD without ATG (P = .001), as well as URD with ATG (P = .01), relative to haploidentical transplants. Similarly, relative to haploidentical transplants, risk of chronic GVHD was higher in URD without ATG and URD with ATG (P < .0001). Cumulative incidence of relapse/progression at 3 years was 36%, 28%, and 36% in the haploidentical, URD without ATG, and URD with ATG groups, respectively (P = .07). Corresponding 3-year overall survival (OS) was 60%, 62%, and 50% in the 3 groups, respectively, with multivariate analysis showing no survival difference between URD without ATG (P = .21) or URD with ATG (P = .16), relative to haploidentical transplants. Multivariate analysis showed no difference between the 3 groups in terms of nonrelapse mortality (NRM), relapse/progression, and progression-free survival (PFS). These data suggest that reduced-intensity conditioning haploidentical transplantation with posttransplant cyclophosphamide does not compromise early survival outcomes compared with matched URD transplantation, and is associated with significantly reduced risk of chronic GVHD.

Comment in

PMID:
26670632
PMCID:
PMC4760094
DOI:
10.1182/blood-2015-09-671834
[Indexed for MEDLINE]
Free PMC Article

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