Outcomes of Advanced Hodgkin Lymphoma after Umbilical Cord Blood Transplantation: A Eurocord and EBMT Lymphoma and Cellular Therapy & Immunobiology Working Party Study
Por:
Paviglianiti, A, Maio, KT, Rocha, V, Gehlkopf, E, Milpied, N, Esquirol, A, Chevallier, P, Blaise, D, Gac, AC, Leblond, V, Cahn, JY, Abecasis, M, Zuckerman, T, Schouten, H, Gurman, G, Rubio, MT, Beguin, Y, Corral, LL, Nagler, A, Snowden, JA, Koc, Y, Mordini, N, Bonifazi, F, Volt, F, Kenzey, C, Robinson, SP, Montoto, S, Gluckman, E, Ruggeri, A
Publicada:
1 nov 2018
Resumen:
Allogeneic stem cell transplantation is an alternative for patients with relapsed or refractory Hodgkin lymphoma (HL), but only limited data on unrelated umbilical cord blood transplantation (UCBT) are available. We analyzed 131 adults with HL who underwent UCBT in European Society for Blood and Marrow Transplantation centers from 2003 to 2015. Disease status at UCBT was complete remission (CR) in 59 patients (47%), and almost all patients had received a previous autologous stem cell transplantation. The 4-year progression-free survival (PFS) and overall survival (OS) were 26% (95% confidence interval [CI], 19% to 34%) and 46% (95% CI, 37% to 55%), respectively. Relapse incidence was 44% (95% CI, 36% to 54%), and nonrelapse mortality (NRM) was 31% (95% CI, 23% to 40%) at 4 years. In multivariate analysis refractory/relapsed disease status at UCBT was associated with increased relapse incidence (hazard ratio [HA], 3.14 [95% CI, 1.41 to 7.00], P = .005) and NRM (HR, 3.61 [95% CI, 1.58 to 827], P = .002) and lower PFS (HR, 3.45 [95% CI, 1.95 to 6.10], P < .001) and OS (HR, 3.10 [95% CI, 1.60 to 5.99], P= .001). Conditioning regimen with cyclophosphamide + fludarabine + 2 Gy total body irradiation (Cy+Flu+2GyTBI) was associated with decreased risk of NRM (HR, .26 [95% CI, .10 to .64], P = .004). Moreover, Cy+Flu+2GyTBI conditioning regimen was associated with a better OS (HR, .25 [95% CI, .12 to .50], P < .001) and PFS (HR, .51 [95% CI, .27 to .96], P = .04). UCBT is feasible in heavily pretreated patients with HL The reduced-intensity conditioning regimen with Cy+Flu+2GyTBI is associated with a better OS and NRM. However, outcomes are poor in patients not in CR at UCBT. (C) 2018 American Society for Blood and Marrow Transplantation.
Filiaciones:
Paviglianiti, A:
Hop St Louis, Eurocord, Paris, France
Ctr Sci Monaco, Monacord, Monaco, Monaco
Maio, KT:
Hop St Louis, Eurocord, Paris, France
Ctr Sci Monaco, Monacord, Monaco, Monaco
Rocha, V:
Hop St Louis, Eurocord, Paris, France
Ctr Sci Monaco, Monacord, Monaco, Monaco
Hosp Sao Paulo, Dept Haematol, Sao Paulo, Brazil
Gehlkopf, E:
CHU Lapeyronie, Serv Hematol, Montpellier, France
Milpied, N:
CHU Bordeaux, Hop Haut Leveque, Serv Hematol & Therapie Cellulaire, Pessac, France
Esquirol, A:
Hosp Santa Creu & Sant Pau, Jose Carreras Leukaemia Res Inst, Clin Hematol Serv, Barcelona, Spain
Chevallier, P:
Hop Hotel Dieu, Serv Hematol, Nantes, France
Blaise, D:
Inst Paoli Calmettes, Serv Hematol & Therapie Cellulaire, Marseille, France
Gac, AC:
Inst Hematol Basse Normandie, Caen, France
Leblond, V:
Hop La Pitie Salpetriere, Hematol Clin, Paris, France
Cahn, JY:
CHU Grenoble Alpes, Hematol Clin, Grenoble, France
Abecasis, M:
Inst Portugues Oncol Francisco Gentil, BMT Unit, Lisbon, Portugal
Zuckerman, T:
Rambam Med Ctr, Dept Hematol, Haifa, Israel
Rambam Med Ctr, BMT, Haifa, Israel
Schouten, H:
Univ Hosp Maastricht, Dept Internal Med Hematol & Oncol, Maastricht, Netherlands
Gurman, G:
Ankara Univ, Dept Hematol, Adult Stem Cell Transplantat Unit, Ankara, Turkey
Rubio, MT:
Hopitaux Brabois, Serv Hematol & Therapie Cellulaire, Nancy, France
Beguin, Y:
CHU Liege, Dept Hematol, Liege, Belgium
Univ Liege, Liege, Belgium
Corral, LL:
Complejo Asistencial Univ Salamanca IBSAL, Hematol Dept, Ctr Invest Canc IBMCC, Salamanca, Spain
Nagler, A:
Chaim Sheba Med Ctr, Dept Hematol, Tel Hashomer, Israel
Snowden, JA:
Sheffield Teaching Hosp NHS Trust, Dept Haematol, Sheffield, S Yorkshire, England
Koc, Y:
Med Pk Hosp, Stem Cell Transplant Unit, Antalya, Turkey
Mordini, N:
Az Osped S Croce & Carle, Div Hematol, Cuneo, Italy
Bonifazi, F:
Seragnoli Univ Hosp S Orsola Malpighi, Inst Hematol, Bologna, Italy
Volt, F:
Hop St Louis, Eurocord, Paris, France
Ctr Sci Monaco, Monacord, Monaco, Monaco
Kenzey, C:
Hop St Louis, Eurocord, Paris, France
Ctr Sci Monaco, Monacord, Monaco, Monaco
Robinson, SP:
EBMT Lymphoma Working Party, Bristol Oncol Ctr, Bristol, Avon, England
Montoto, S:
EBMT Lymphoma Working Party, Barts Hlth NHS Trust, St Bartholomews Hosp, Dept Haematooncol, London, England
Gluckman, E:
Hop St Louis, Eurocord, Paris, France
Ctr Sci Monaco, Monacord, Monaco, Monaco
Ruggeri, A:
Hop St Louis, Eurocord, Paris, France
Ctr Sci Monaco, Monacord, Monaco, Monaco
Osped Pediat Bambin Gesu, Hematol Dept, Dipartimento Oncoematol & Terapia Cellulare & Gen, Rome, Italy
hybrid, Green Published
|