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.
Adolescent
Adult
Aged
Allografts
Cyclophosphamide
/ administration & dosage
Disease-Free Survival
Female
Graft vs Host Disease
/ mortality
Hematopoietic Stem Cell Transplantation
Hodgkin Disease
/ mortality
Humans
Male
Middle Aged
Recurrence
Siblings
Survival Rate
Tissue Donors
Transplantation Conditioning
Allogeneic transplantation
Alternative donor
Haploidentical transplantation
Hodgkin lymphoma
Journal
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
ISSN: 1523-6536
Titre abrégé: Biol Blood Marrow Transplant
Pays: United States
ID NLM: 9600628
Informations de publication
Date de publication:
09 2019
09 2019
Historique:
received:
26
02
2019
revised:
30
04
2019
accepted:
20
05
2019
pubmed:
28
5
2019
medline:
30
7
2020
entrez:
28
5
2019
Statut:
ppublish
Résumé
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.
Identifiants
pubmed: 31132455
pii: S1083-8791(19)30336-2
doi: 10.1016/j.bbmt.2019.05.025
pmc: PMC6755039
mid: NIHMS1530964
pii:
doi:
Substances chimiques
Cyclophosphamide
8N3DW7272P
Types de publication
Clinical Trial
Comparative Study
Journal Article
Multicenter Study
Observational Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
1859-1868Subventions
Organisme : NCI NIH HHS
ID : P30 CA008748
Pays : United States
Organisme : NCI NIH HHS
ID : P30 CA086862
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL069294
Pays : United States
Organisme : NCI NIH HHS
ID : U24 CA076518
Pays : United States
Informations de copyright
Copyright © 2019 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.
Références
J Clin Oncol. 2007 Feb 10;25(5):579-86
pubmed: 17242396
J Clin Oncol. 2008 Jan 20;26(3):455-62
pubmed: 18086796
Biol Blood Marrow Transplant. 2008 May;14(5):538-45
pubmed: 18410896
Biol Blood Marrow Transplant. 2008 Nov;14(11):1279-87
pubmed: 18940683
Biol Blood Marrow Transplant. 2009 Dec;15(12):1628-33
pubmed: 19896087
Biol Blood Marrow Transplant. 2012 Jul;18(7):1036-1043.e1
pubmed: 22155506
J Clin Oncol. 2012 Jun 20;30(18):2183-9
pubmed: 22454421
Ann Oncol. 2013 Sep;24(9):2430-4
pubmed: 23712545
Bone Marrow Transplant. 2014 Feb;49(2):190-4
pubmed: 24185585
Blood. 2016 Feb 18;127(7):938-47
pubmed: 26670632
J Clin Oncol. 2016 Sep 10;34(26):3141-9
pubmed: 27269951
Lancet Oncol. 2016 Sep;17(9):1283-94
pubmed: 27451390
Blood. 2017 Mar 9;129(10):1380-1388
pubmed: 28073785
Bone Marrow Transplant. 2017 May;52(5):683-688
pubmed: 28092347
Blood. 2017 Jul 13;130(2):221-228
pubmed: 28468799
J Clin Oncol. 2017 Sep 10;35(26):3002-3009
pubmed: 28644773
J Clin Oncol. 2017 Oct 20;35(30):3425-3432
pubmed: 28846465
Biol Blood Marrow Transplant. 2018 Mar;24(3):627-632
pubmed: 29197681
Blood Adv. 2017 Dec 12;1(26):2643-2654
pubmed: 29296917
Bone Marrow Transplant. 2018 Apr;53(4):400-409
pubmed: 29330405
J Clin Oncol. 2018 May 10;36(14):1428-1439
pubmed: 29584546
Blood. 2018 Jul 5;132(1):9-16
pubmed: 29720488
Am J Med. 1980 Aug;69(2):204-17
pubmed: 6996481
Bone Marrow Transplant. 1995 Jun;15(6):825-8
pubmed: 7581076
J Clin Oncol. 1996 Feb;14(2):572-8
pubmed: 8636773
J Clin Oncol. 1996 Apr;14(4):1291-6
pubmed: 8648386
Lifetime Data Anal. 1995;1(2):145-56; discussion 157-9
pubmed: 9385097