Reduced-intensity and non-myeloablative allogeneic stem cell transplantation from alternative HLA-mismatched donors for Hodgkin lymphoma: a study by the French Society of Bone Marrow Transplantation and Cellular Therapy

Bone Marrow Transplant. 2017 May;52(5):689-696. doi: 10.1038/bmt.2016.349. Epub 2017 Jan 9.

Abstract

Allogeneic stem cell transplantation (allo-SCT) following a non-myeloablative (NMA) or reduced-intensity conditioning (RIC) is considered a valid approach to treat patients with refractory/relapsed Hodgkin lymphoma (HL). When an HLA-matched donor is lacking a graft from a familial haploidentical (HAPLO) donor, a mismatched unrelated donor (MMUD) or cord blood (CB) might be considered. In this retrospective study, we compared the outcome of patients with HL undergoing a RIC or NMA allo-SCT from HAPLO, MMUD or CB. Ninety-eight patients were included. Median follow-up was 31 months for the whole cohort. All patients in the HAPLO group (N=34) received a T-cell replete allo-SCT after a NMA (FLU-CY-TBI, N=31, 91%) or a RIC (N=3, 9%) followed by post-transplant cyclophosphamide. After adjustment for significant covariates, MMUD and CB were associated with significantly lower GvHD-free relapse-free survival (GRFS; hazard ratio (HR)=2.02, P=0.03 and HR=2.43, P=0.009, respectively) compared with HAPLO donors. In conclusion, higher GRFS was observed in Hodgkin lymphoma patients receiving a RIC or NMA allo-SCT with post-transplant cyclophosphamide from HAPLO donors. Our findings suggest they should be favoured over MMUD and CB in this setting.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Adult
  • Cord Blood Stem Cell Transplantation
  • Cyclophosphamide / therapeutic use*
  • Disease-Free Survival
  • Female
  • Follow-Up Studies
  • Graft vs Host Disease
  • HLA Antigens
  • Histocompatibility
  • Hodgkin Disease / mortality
  • Hodgkin Disease / therapy*
  • Humans
  • Male
  • Retrospective Studies
  • Stem Cell Transplantation / methods*
  • Stem Cell Transplantation / standards
  • Transplantation Conditioning / methods*
  • Transplantation, Haploidentical*
  • Transplantation, Homologous
  • Unrelated Donors / supply & distribution

Substances

  • HLA Antigens
  • Cyclophosphamide