Haploidentical related donor compared to HLA-identical donor transplantation for chemosensitive Hodgkin lymphoma patients.

Adolescent Adult Aged Antineoplastic Combined Chemotherapy Protocols / therapeutic use Combined Modality Therapy Female Follow-Up Studies HLA Antigens / immunology Hematopoietic Stem Cell Transplantation / mortality Hodgkin Disease / immunology Humans Male Middle Aged Prognosis Retrospective Studies Siblings Survival Rate Tissue Donors / supply & distribution Transplantation Conditioning Transplantation, Haploidentical / mortality Transplantation, Homologous Young Adult

Haploidentical transplantation Hodgkin lymphoma Reduced intensity conditioning regimen

Journal

BMC cancer

ISSN: 1471-2407

Titre abrégé: BMC Cancer

Pays: England

ID NLM: 100967800

Informations de publication

Date de publication:
24 Nov 2020

Historique:

received: 18 05 2020

accepted: 30 10 2020

entrez: 25 11 2020

pubmed: 26 11 2020

medline: 28 4 2021

Statut: epublish

Résumé

Allogeneic stem cell transplantation from haploidentical donor using an unmanipulated graft and post-transplantation cyclophosphamide (PT-Cy) is growing. Haploidentical transplantation with PT-Cy showed a major activity in Hodgkin lymphoma (HL), reducing the relapse incidence. The most important predictive factor of survival and toxicity was disease status before transplantation, which was better in patients with well controlled disease. We included 198 HL in complete (CR) or partial remission (PR) before transplantation. Sixty-five patients were transplanted from haploidentical donor and 133 from a HLA identical donor (both sibling and unrelated donors). Survival analysis was defined according to the EBMT criteria. Survival curves were generated by using Kaplan-Meier method and differences between groups were compared by the log rank test or by the log rank test for trend when appropriated. The PFS, OS, and RI were significantly better in patients in CR compared to PR (55% vs 29% p = 0.001, 74% vs 55% p = 0.03, 27% vs 55% p < 0.001, respectively). The 2-year PFS was significantly better for HAPLO than HLA-id (63% vs 37%, p = 0.03), without difference in OS. The 1-year NRM was not different. The 2-year relapse incidence (RI) was lower in the HAPLO group (24% vs 44%, p = 0.008). Patients in CR receiving haplo HSCT showed higher 2-year PFS and lower 2-year RI than those allografted with HLA-id donor (75% vs 47%, p < 0.001 and 11% vs 34%, p < 0.001, respectively). In multivariate analysis, donor type and disease status before transplantation were independent predictors of PFS as well as they predict the risk of relapse. Disease status at transplantation and age were independently associated to OS. Nonetheless this is a retrospective study, limiting the wide applicability of results, data from this analysis suggest that HLA mismatch can induce a strong graft versus lymphoma effect leading to an enhanced PFS.

Sections du résumé

BACKGROUND BACKGROUND

METHODS METHODS

We included 198 HL in complete (CR) or partial remission (PR) before transplantation. Sixty-five patients were transplanted from haploidentical donor and 133 from a HLA identical donor (both sibling and unrelated donors). Survival analysis was defined according to the EBMT criteria. Survival curves were generated by using Kaplan-Meier method and differences between groups were compared by the log rank test or by the log rank test for trend when appropriated.

RESULTS RESULTS

The PFS, OS, and RI were significantly better in patients in CR compared to PR (55% vs 29% p = 0.001, 74% vs 55% p = 0.03, 27% vs 55% p < 0.001, respectively). The 2-year PFS was significantly better for HAPLO than HLA-id (63% vs 37%, p = 0.03), without difference in OS. The 1-year NRM was not different. The 2-year relapse incidence (RI) was lower in the HAPLO group (24% vs 44%, p = 0.008). Patients in CR receiving haplo HSCT showed higher 2-year PFS and lower 2-year RI than those allografted with HLA-id donor (75% vs 47%, p < 0.001 and 11% vs 34%, p < 0.001, respectively). In multivariate analysis, donor type and disease status before transplantation were independent predictors of PFS as well as they predict the risk of relapse. Disease status at transplantation and age were independently associated to OS.

CONCLUSIONS CONCLUSIONS

Nonetheless this is a retrospective study, limiting the wide applicability of results, data from this analysis suggest that HLA mismatch can induce a strong graft versus lymphoma effect leading to an enhanced PFS.

Identifiants

DOI: 10.1186/s12885-020-07602-w PMID: 33234127 PMC: PMC7685618

pubmed: 33234127

doi: 10.1186/s12885-020-07602-w

pii: 10.1186/s12885-020-07602-w

pmc: PMC7685618

doi:

Substances chimiques

HLA Antigens 0

Types de publication

Comparative Study Journal Article

Langues

eng

Sous-ensembles de citation

Pagination

1140

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