Patients with Hodgkin’s lymphoma (HL) who undergo post-translational cyclophosphamide-based haploidentical (HAPLO) allogeneic hematopoietic cell transplantation may achieve similar survival outcomes as HLA-matched sibling donor (SIB) and HLA-matched unrelated donor (MUD) transplantations, and experience a lower rate of graft-versus-host disease (GVHD) than MUD, according to a study published in the Journal of Clinical Oncology.1

In this retrospective study, researchers evaluated the outcomes of 709 adult patients with HL who received HAPLO, SIB, or MUD transplantations. The study also assessed a novel composite end point defined as chronic GVHD-free, relapse-free survival (cGRFS). The median follow-up was 29 months.

The 1-year cumulative incidence of nonrelapse mortality for patients receiving HAPLO, SIB, and MUD was 17%, 13%, and 21%, respectively, and 2-year cumulative incidence of relapse or progression was 39%, 49%, and 32%, respectively. A multivariable analysis relative to SIB found that the risk of relapse was lower for both HAPLO (P = .047) and MUD (P < .001), and nonrelapse mortality was similar in HAPLO (P = .26) but greater in MUD (P < .001).

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Two-year overall survival (OS) was 67%, 71%, and 62% for HAPLO, SIB, and MUD, respectively, and progression-free survival (PFS) was 43%, 38%, and 45%, respectively, but no significant differences in OS and PFS were found between the 3 groups.

Investigators found that there were no significant differences in the incidence of GVHD between groups, but the 1-year cumulative incidence of GVHD was higher in MUD (41%) compared to SIB (25%; P < .012) and HAPLO (26%; P = .04).

Patients who received HAPLO had a significantly better rate of cGRFS compared to SIB (40% vs 28%; P = .049), and a similar rate to MUD (38%; P = .59).

The authors conclude by saying “whether HAPLO transplantation is the first choice instead of MUD transplantation and whether it can eventually substitute SIB transplantation in specific subgroups of patients must be assessed within the context of a randomized prospective clinical trial.”

Reference

  1. Martinez C, Gayoso J, Canals C, et al. Post-transplantation cyclophosphamide-based haploidentical transplantation as alternative to matched sibling or unrelated donor transplantation for Hodgkin lymphoma: a registry study of the lymphoma working party of the European Society for Blood and Marrow Transplantation. J Clin Oncol. 2017 Aug 28. [Epub ahead of print]. doi: 10.1200/JCO.2017.72.6869

Topics:

Hematologic Cancers Lymphoma