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
Ahmed, Sairah (University of Texas)
Kanakry, Jennifer A. (National Institutes of Health (Bethesda, Estats Units d'Amèrica))
Ahn, Kwang Woo (Medical College of Wisconsin)
Litovich, Carlos Alejandro (Medical College of Wisconsin)
Abdel-Azim, Hisham (University of Southern California Keck School of Medicine)
Aljurf, Mahmoud Deeb (King Faisal Specialist Hospital and Research Centre (Aràbia Saudita))
Bacher, Vera Ulrike (Inselspital. Bern University Hospital)
Bejanyan, Nelli (Immunotherapy. Moffitt Cancer Center)
Cohen, Jonathon B. (Emory University School of Medicine)
Farooq, Umar (University of Iowa Hospitals and Clinics)
Fuchs, Ephraim Joseph (The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins)
Bolaños-Meade, Javier (The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins)
Ghosh, Nilanjan S. (Levine Cancer Institute. Atrium Health)
Herrera, Alex F. (City of Hope National Medical Center)
Hossain, Nasheed (Loyola University Chicago-Stritch School of Medicine)
Inwards, David (Mayo Clinic)
Kanate, Abraham Sebastian (West Virginia University)
Martino Bofarull, Rodrigo (Institut d'Investigació Biomèdica Sant Pau)
Munshi, Pashna (Georgetown University Hospital)
Murthy, Hemant S. (University Florida College of Medicine)
Mussetti, Alberto (Institut Català d'Oncologia-Hospitalet)
Nieto, Yago (University of Texas)
Perales, Miguel-Angel (Memorial Sloan Kettering Cancer Center)
Romee, Rizwan (Dana-Farber Cancer Institute (Boston, Estats Units d'Amèrica))
Savani, Bipin N. (Vanderbilt University Medical Center)
Seo, Sachiko (Dokkyo Medical University)
Wirk, Baldeep Mona (Seattle Cancer Care Alliance)
Yared, Jean A. (University of Maryland)
Sureda, Anna (Institut Català d'Oncologia-Hospitalet)
Fenske, Timothy S. (Medical College of Wisconsin)
Hamadani, Mehdi (Medical College of Wisconsin)
Universitat Autònoma de Barcelona

Data:	2019
Resum:	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.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Allogeneic transplantation ; Alternative donor ; Haploidentical transplantation ; Hodgkin lymphoma
Publicat a:	Biology of blood and marrow transplantation, Vol. 25 Núm. 9 (september 2019) , p. 1859-1868, ISSN 1523-6536

DOI: 10.1016/j.bbmt.2019.05.025
PMID: 31132455

10 p, 680.7 KB

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