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.
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BORIS DOI
Date of Publication
September 2019
Publication Type
Article
Division/Institute
Author
Ahmed, Sairah | |
Kanakry, Jennifer A | |
Ahn, Kwang W | |
Litovich, Carlos | |
Abdel-Azim, Hisham | |
Aljurf, Mahmoud | |
Bejanyan, Nelli | |
Cohen, Jonathon B | |
Farooq, Umar | |
Fuchs, Ephraim J | |
Bolaños-Meade, Javier | |
Ghosh, Nilanjan | |
Herrera, Alex F | |
Hossain, Nasheed M | |
Inwards, David | |
Kanate, Abraham S | |
Martino, Rodrigo | |
Munshi, Pashna N | |
Murthy, Hemant | |
Mussetti, Alberto | |
Nieto, Yago | |
Perales, Miguel-Angel | |
Romee, Rizwan | |
Savani, Bipin N | |
Seo, Sachiko | |
Wirk, Baldeep | |
Yared, Jean A | |
Sureda, Ana | |
Fenske, Timothy S | |
Hamadani, Mehdi |
Subject(s)
Series
Biology of blood and marrow transplantation
ISSN or ISBN (if monograph)
1083-8791
Publisher
Elsevier
Language
English
Publisher DOI
PubMed ID
31132455
Uncontrolled Keywords
Description
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.