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Haploidentical Related Donor vs Unrelated Cord Blood Hematopoietic Cell Transplantation for Hodgkin and Non-Hodgkin Lymphomas


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In a retrospective analysis reported in the Journal of Clinical Oncology, Fatobene et al found that nonmyeloablative haploidentical related donor cell transplantation was associated with better outcomes compared to unrelated cord blood hematopoietic transplantation in patients with Hodgkin and non-Hodgkin lymphomas.

Study Details

The study involved data from 740 patients with Hodgkin lymphoma (n = 283) or non-Hodgkin lymphoma (n = 457) aged 18 to 75 years who underwent transplantation between 2009 and 2016. All 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.

A total of 526 patients received haploidentical transplantation, with 68% receiving bone marrow and 32% receiving peripheral blood transplantation. All patients received a transplantation conditioning regimen consisting of 2 Gy of total-body irradiation, cyclophosphamide, and fludarabine, as well as graft-vs-host disease prophylaxis consisting of a calcineurin inhibitor and mycophenolate. Patients receiving a haploidentical transplantation also received posttransplantation cyclophosphamide.

Progression-Free and Overall Survival

Median follow-up ranged from 30 to 48 months among patient groups.

KEY POINTS

  • Haploidentical bone marrow and peripheral blood transplantation were associated with better overall and progression-free survival vs unrelated cord blood hematopoietic transplantation.
  • No difference in outcomes was observed for bone marrow vs peripheral blood transplantation.

The 4-year probability of overall survival was 58% among patients receiving haploidentical bone marrow transplantation, 59% among those receiving haploidentical peripheral-blood transplantation, and 49% among those receiving unrelated cord blood hematopoietic transplantation. The 4-year probability of progression-free survival was 46%, 52%, and 36%, respectively.

In analysis adjusted for age, lymphoma subtype, and disease status, compared with haploidentical bone marrow and peripheral blood transplantation, unrelated cord blood hematopoietic transplantation was associated with poorer overall survival (hazard ratios [HRs] = 1.55, P = .001, and 1.59, P = .005) and progression-free survival (HRs = 1.44, P = .002, and 1.86, P < .0001). No significant differences in overall survival (HR = 1.00, P = .97) or progression-free survival (HR = 1.28, P = .10) were observed for peripheral blood vs bone marrow transplantation. Poorer survival in the unrelated cord blood hematopoietic transplant group was attributable to higher transplantation-related mortality compared to that after haploidentical bone marrow transplant (HR = 1.91, P = .0001) or peripheral blood transplant (HR = 2.27, P = .0002).

Among all patients, compared with those with Hodgkin lymphoma, transplantation-related mortality and relapse or progression rates were higher and progression-free and overall survival poorer in patients with diffuse large B-cell and mantle cell lymphoma, but not in those with other non-Hodgkin lymphoma subtypes.

The investigators concluded: “When considering human leukocyte antigen–mismatched transplantation for Hodgkin or non-Hodgkin lymphoma, the data support haploidentical related donor transplantation over [unrelated cord blood hematopoietic] transplantation.”

Mary Eapen, MBBS, MS, of the Department of Medicine, Medical College of Wisconsin, Milwaukee, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: The study was supported by the National Cancer Institute, National Heart, Lung, and Blood Institute, National Institute of Allergy and Infectious Diseases, and others. For full disclosures of the study authors, visit ascopubs.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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