Impact of type of reduced-intensity conditioning regimen on the outcomes of allogeneic haematopoietic cell transplantation in classical Hodgkin lymphoma.
Adolescent
Adult
Aged
Allografts
Busulfan
/ administration & dosage
Cause of Death
Comorbidity
Cyclophosphamide
Female
Graft vs Host Disease
/ etiology
Hematopoietic Stem Cell Transplantation
/ adverse effects
Hodgkin Disease
/ drug therapy
Humans
Kaplan-Meier Estimate
Male
Melphalan
/ administration & dosage
Middle Aged
Myeloablative Agonists
/ administration & dosage
Progression-Free Survival
Recurrence
Siblings
Transplantation Conditioning
/ adverse effects
Unrelated Donors
Vidarabine
/ administration & dosage
Young Adult
allogeneic hematopoietic cell transplant
classical Hodgkin lymphoma
reduced-intensity conditioning
Journal
British journal of haematology
ISSN: 1365-2141
Titre abrégé: Br J Haematol
Pays: England
ID NLM: 0372544
Informations de publication
Date de publication:
08 2020
08 2020
Historique:
received:
17
01
2020
revised:
17
03
2020
accepted:
22
03
2020
pubmed:
22
4
2020
medline:
5
3
2021
entrez:
22
4
2020
Statut:
ppublish
Résumé
Reduced-intensity conditioning (RIC) allogeneic haematopoietic cell transplantation (allo-HCT) is a curative option for select relapsed/refractory Hodgkin lymphoma (HL) patients; however, there are sparse data to support superiority of any particular conditioning regimen. We analyzed 492 adult patients undergoing human leucocyte antigen (HLA)-matched sibling or unrelated donor allo-HCT for HL between 2008 and 2016, utilizing RIC with either fludarabine/busulfan (Flu/Bu), fludarabine/melphalan (Flu/Mel140) or fludarabine/cyclophosphamide (Flu/Cy). Multivariable regression analysis was performed using a significance level of <0·01. There were no significant differences between regimens in risk for non-relapse mortality (NRM) (P = 0·54), relapse/progression (P = 0·02) or progression-free survival (PFS) (P = 0·14). Flu/Cy conditioning was associated with decreased risk of mortality in the first 11 months after allo-HCT (HR = 0·28; 95% CI = 0·10-0·73; P = 0·009), but beyond 11 months post allo-HCT it was associated with a significantly higher risk of mortality, (HR = 2·46; 95% CI = 0·1.32-4·61; P = 0·005). Four-year adjusted overall survival (OS) was similar across regimens at 62% for Flu/Bu, 59% for Flu/Mel140 and 55% for Flu/Cy (P = 0·64), respectively. These data confirm the choice of RIC for allo-HCT in HL does not influence risk of relapse, NRM or PFS. Although no OS benefit was seen between Flu/Bu and Flu/Mel 140; Flu/Cy was associated with a significantly higher risk of mortality beyond 11 months from allo-HCT (possibly due to late NRM events).
Identifiants
pubmed: 32314807
doi: 10.1111/bjh.16664
pmc: PMC7575614
mid: NIHMS1597010
doi:
Substances chimiques
Myeloablative Agonists
0
Cyclophosphamide
8N3DW7272P
Vidarabine
FA2DM6879K
Busulfan
G1LN9045DK
Melphalan
Q41OR9510P
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
573-582Subventions
Organisme : NHLBI NIH HHS
ID : U10 HL069294
Pays : United States
Organisme : NCI NIH HHS
ID : U24 CA076518
Pays : United States
Organisme : Office of Naval Research
ID : N00014-17-1-2388
Organisme : NCI NIH HHS
ID : P30 CA008748
Pays : United States
Organisme : Office of Naval Research
ID : N00014-16-1-2020
Organisme : National Heart, Lung and Blood Institute
ID : 4U10HL069294
Organisme : NCI NIH HHS
ID : P30 CA086862
Pays : United States
Organisme : Public Health Service
ID : 5U24CA076518
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2020 British Society for Haematology and John Wiley & Sons Ltd.
Références
Ann Oncol. 2016 Dec;27(12):2251-2257
pubmed: 28007754
J Clin Oncol. 1996 Apr;14(4):1291-6
pubmed: 8648386
Am J Med. 1980 Aug;69(2):204-17
pubmed: 6996481
Blood. 2017 Mar 9;129(10):1380-1388
pubmed: 28073785
J Clin Oncol. 2007 Feb 10;25(5):579-86
pubmed: 17242396
JAMA Oncol. 2019 May 1;5(5):715-722
pubmed: 30816957
Biol Blood Marrow Transplant. 2018 Mar;24(3):627-632
pubmed: 29197681
Biol Blood Marrow Transplant. 2016 Sep;22(9):1543-1551
pubmed: 27131863
Lifetime Data Anal. 1995;1(2):145-56; discussion 157-9
pubmed: 9385097
Bone Marrow Transplant. 2015 Nov;50(11):1416-23
pubmed: 26237164
Biol Blood Marrow Transplant. 2006 Feb;12(2):172-83
pubmed: 16443515
Biol Blood Marrow Transplant. 2019 Sep;25(9):1859-1868
pubmed: 31132455
Haematologica. 2009 Feb;94(2):230-8
pubmed: 19066328
Blood Adv. 2018 Apr 24;2(8):933-940
pubmed: 29685953
Bone Marrow Transplant. 2017 Nov;52(11):1487-1494
pubmed: 28368373
Biol Blood Marrow Transplant. 2019 Jan;25(1):86-93
pubmed: 30219698
Blood Adv. 2017 Dec 12;1(26):2643-2654
pubmed: 29296917
Lancet. 2005 Jun 4-10;365(9475):1934-41
pubmed: 15936420
Blood. 2016 Feb 18;127(7):938-47
pubmed: 26670632
J Clin Oncol. 2008 Jan 20;26(3):455-62
pubmed: 18086796
Bone Marrow Transplant. 1995 Jun;15(6):825-8
pubmed: 7581076
J Hematol Oncol. 2017 Jun 12;10(1):117
pubmed: 28606176
J Clin Oncol. 2017 Oct 20;35(30):3425-3432
pubmed: 28846465
Blood. 2017 Jul 13;130(2):221-228
pubmed: 28468799
J Clin Oncol. 1996 Feb;14(2):572-8
pubmed: 8636773
Bone Marrow Transplant. 2008 May;41(9):765-70
pubmed: 18195684
J Clin Oncol. 2001 Mar 1;19(5):1395-404
pubmed: 11230484
J Clin Oncol. 2016 Sep 10;34(26):3141-9
pubmed: 27269951
Biol Blood Marrow Transplant. 2009 Dec;15(12):1628-33
pubmed: 19896087
Br J Haematol. 2011 Feb;152(3):261-72
pubmed: 21155760
Biol Blood Marrow Transplant. 2015 Sep;21(9):1679-1686
pubmed: 26028504
Biol Blood Marrow Transplant. 2016 Oct;22(10):1808-1815
pubmed: 27470290
Blood Adv. 2019 Feb 12;3(3):360-369
pubmed: 30723110
Bone Marrow Transplant. 2015 Mar;50(3):367-74
pubmed: 25437248
Biol Blood Marrow Transplant. 2009 Jan;15(1):109-17
pubmed: 19135949