Posttransplantation Cyclophosphamide-Based Haploidentical HCT in Hodgkin Lymphoma

Key Points

  • Progression-free and overall survival with haploidentical allogeneic HCT was similar compared with HLA-matched sibling donor and HLA-matched unrelated donor.
  • Haploidentical allogeneic HCT was associated with a lower risk of chronic graft-vs-host disease vs HLA-matched unrelated donor.

In a European analysis reported in the Journal of Clinical Oncology, Martínez et al found similar survival outcomes with post-transplantation cyclophosphamide-based haploidentical allogeneic hematopoietic cell transplantation (HCT) vs conventional HLA-matched sibling donor or HLA-matched unrelated donor transplantation in patients with Hodgkin lymphoma. Haploidentical allogeneic HCT was associated with reduced risk of chronic graft-vs-host disease vs HLA-matched unrelated donor.

Study Details

The retrospective study involved 709 adult patients registered in the European Society for Blood and Marrow Transplantation database who received haploidentical allogeneic HCT (n = 98), HLA-matched sibling donor (n = 338), or HLA-matched unrelated donor (n = 273) transplantation.

Graft-vs-Host Disease and Survival

Median follow-up among survivors was 29 months. Grade III or IV acute graft-vs-host disease occurred in 9% of the haploidentical allogeneic HCT group, 6% of the HLA-matched sibling donor group, and 9% of the HLA-matched unrelated donor group (overall P = .54). Cumulative incidence of chronic graft-vs-host disease at 1 year was 26%, 25%, and 41% (overall P = .017, P = .04 for haploidentical allogeneic HCT vs HLA-matched unrelated donor transplant.

Cumulative incidence of nonrelapse mortality at 1 year was 17%, 13%, and 21% (overall P = .23) and 2-year cumulative incidence of relapse or progression was 39%, 49%, and 32% (overall P < .001). On multivariable analysis, compared with HLA-matched sibling donor, nonrelapse mortality did not differ with haploidentical allogeneic HCT and was higher with HLA-matched unrelated donor transplant (P = .003) and relapse risk was lower with both haploidentical allogeneic HCT (P = .047) and HLA-matched unrelated donor transplant (P < .001). Two-year progression-free survival was 43%, 38%, and 45% (overall P = .086) and 2-year overall survival was 67%, 71%, and 62% (overall P = .118).

The rate of the composite end point of 2-year extensive chronic graft-vs-host disease– and relapse-free survival with haploidentical allogeneic HCT (40%) was significantly better vs HLA-matched sibling donor (28%, P = .049) and similar vs HLA-matched unrelated donor transplant (38%, P = .59).

The investigators concluded: “Post-transplantation cyclophosphamide-based [haploidentical allogeneic HCT] results in similar survival outcomes compared with [HLA-matched sibling donor] and [HLA-matched unrelated donor], which confirms its suitability when no conventional donor is available. Our results also suggest that [haploidentical allogeneic HCT] results in a lower risk of chronic [graft-vs-host disease] than [HLA-matched unrelated donor] transplantation.”

Carmen Martínez, MD, of the Institute of Hematology and Oncology, Hospital Clínic Barcelona, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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