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
Por:
Ahmed, S, Kanakry, JA, Ahn, KW, Litovich, C, Abdel-Azim, H, Aljurf, M, Bacher, VU, Bejanyan, N, Cohen, JB, Farooq, U, Fuchs, EJ, Bolanos-Meade, J, Ghosh, N, Herrera, AF, Hossain, NM, Inwards, D, Kanate, AS, Martino, R, Munshi, PN, Murthy, H, Mussetti, A, Nieto, Y, Perales, MA, Romee, R, Savani, BN, Seo, S, Wirk, B, Yared, JA, Sureda, A, Fenske, TS, Hamadani, M
Publicada:
1 sep 2019
Resumen:
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) Ha 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% Cl, .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% Cl, .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. (C) 2019 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.
Filiaciones:
Ahmed, S:
Univ Texas MD Anderson Canc Ctr, Houston, TX 77030 USA
Kanakry, JA:
NCI, NIH, Bethesda, MD 20892 USA
Ahn, KW:
Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA
Med Coll Wisconsin, Inst Hlth & Soc, Div Biostat, Milwaukee, WI 53226 USA
Litovich, C:
Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA
Abdel-Azim, H:
Childrens Hosp Los Angeles, Div Hematol Oncol & Blood Ea Marrow Transplantat, Los Angeles, CA 90027 USA
Univ Southern Calif, Keck Sch Med, Los Angeles, CA 90033 USA
Aljurf, M:
King Faisal Specialist Hosp Ctr & Res, Dept Oncol, Riyadh, Saudi Arabia
Bacher, VU:
Bern Univ Hosp, Inselspital, Dept Hematol, Bern, Switzerland
Bejanyan, N:
H Lee Moffitt Canc Ctr & Res Inst, Dept Blood & Marrow Transplant & Cellular Immunot, Tampa, FL USA
Cohen, JB:
Emory Univ, Sch Med, Winship Canc Inst, Dept Hematol & Med Oncol, Atlanta, GA USA
Farooq, U:
Univ Iowa Hosp & Clin, Div Hematol Oncol & Blood & Marrow Transplantat, Iowa City, IA 52242 USA
Fuchs, EJ:
Johns Hopkins, Sidney Kimmel Comprehens Canc Ctr, Baltimore, MD USA
Bolanos-Meade, J:
Johns Hopkins, Sidney Kimmel Comprehens Canc Ctr, Baltimore, MD USA
Ghosh, N:
Atrium Hlth, Levine Canc Inst, Dept Hematol Oncol & Blood Disorders, Charlotte, NC USA
Herrera, AF:
City Hope Natl Med Ctr, Dept Hematol & Hematopoiet Cell Transplantat, 1500 E Duarte Rd, Duarte, CA 91010 USA
Hossain, NM:
Loyola Univ, Chicago Stritch Sch Med, Dept Med, Div Hematol Oncol, Maywood, IL 60153 USA
Inwards, D:
Mayo Clin, Div Hematol, Rochester, MN USA
Kanate, AS:
West Virginia Univ, Osborn Hematopoiet Malignancy & Transplantat Prog, Morgantown, WV 26506 USA
Martino, R:
Hosp Santa Creu & Sant Pau, Div Clin Hematol, Barcelona, Spain
Munshi, PN:
Georgetown Univ Hosp, Washington, DC 20007 USA
Murthy, H:
Univ Florida, Coll Med, Div Hematol Oncol, Gainesville, FL USA
Mussetti, A:
Inst Catala Oncol Hosp, Hematol Dept, Barcelona, Spain
Nieto, Y:
Univ Texas MD Anderson Canc Ctr, Houston, TX 77030 USA
Perales, MA:
Mem Sloan Kettering Canc Ctr, Dept Med, Adult Bone Marrow Transplant Serv, 1275 York Ave, New York, NY 10021 USA
Romee, R:
Dana Farber Canc Inst, Boston, MA 02115 USA
Savani, BN:
Vanderbilt Univ, Med Ctr, Dept Med, Div Hematol Oncol, Nashville, TN 37232 USA
Seo, S:
Dokkyo Med Univ, Dept Haematol & Oncol, Mibu, Tochigi, Japan
Wirk, B:
Seattle Canc Care Alliance, Div Bone Marrow Transplant, Seattle, WA USA
Yared, JA:
Univ Maryland, Greenebaum Comprehens Canc Ctr, Blood & Marrow Transplantat Program, Div Hematol Oncol,Dept Med, Baltimore, MD 21201 USA
Fenske, TS:
Med Coll Wisconsin, Dept Med, Div Hematol & Oncol, Milwaukee, WI 53226 USA
Hamadani, M:
Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA
Green Accepted, Hybrid Gold
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