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J Clin Oncol. 2020 Feb 7:JCO1902408. doi: 10.1200/JCO.19.02408. [Epub ahead of print]

Nonmyeloablative Alternative Donor Transplantation for Hodgkin and Non-Hodgkin Lymphoma: From the LWP-EBMT, Eurocord, and CIBMTR.

Author information

1
Hospital das Clínicas and LIM31, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
2
Hospital Sírio-Libanês, São Paulo, Brazil.
3
Churchill Hospital, Oxford, United Kingdom.
4
Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI.
5
University Hospitals Bristol National Health Service (NHS) Foundation Trust, Bristol, United Kingdom.
6
The Blood and Marrow Transplant Program, Northside Hospital, Atlanta, GA.
7
European Society for Blood and Marrow Transplantation Paris Study Office/European Center for Biostatistical and Epidemiological Evaluation in Hematopoietic Cell Therapy, Paris, France.
8
University of Minnesota Medical Center, Minneapolis, MN.
9
Istituto Clinico Humanitas, Rozzano Milano, Italy.
10
IRCCS Ospedale Policlinico San Martino, Genova, Italy.
11
Division of Hematology, Hôpitaux Universitaires of Geneva, Faculty of Medicine, University of Geneva, Geneva and Swiss Cancer Center Leman, Switzerland.
12
Eurocord, Université de Paris, Institut de Recherche de Saint-Louis (IRSL) EA3518, Paris, France.
13
Division of Hematology-Oncology and Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL.
14
Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Lyon, France.
15
Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.
16
European Institute of Oncology, Milano, Italy.
17
Memorial Sloan Kettering Cancer Center, New York, NY.
18
Department of Pediatric Hematology and Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale Pediatrico Bambino Gesù, Roma, Italy.
19
Clinical Hematology Department, Institut Català d'Oncxologia - Hospitalet, IDIBELL, Universitat de Barcelona, Barcelona, Spain.
20
CHU de Lille, LIRIC, INSERM U995, Université de Lille, Lille, France.
21
Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI.
22
Monacord, Centre Scientifique de Monaco, Monaco.
23
Department of Haemato-Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom.

Abstract

PURPOSE:

To compare the outcomes of patients with Hodgkin or non-Hodgkin lymphoma undergoing nonmyeloablative 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.

PMID:
32031876
DOI:
10.1200/JCO.19.02408

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