Alternative donors extend transplantation for patients with lymphoma who lack an HLA matched donor

V. Bachanova, L. J. Burns, T. Wang, J. Carreras, R. P. Gale, P. H. Wiernik, K. K. Ballen, Baldeep Wirk, R. Munker, D. A. Rizzieri, Y. B. Chen, J. Gibson, G. Akpek, L. J. Costa, R. T. Kamble, M. D. Aljurf, J. W. Hsu, M. S. Cairo, H. C. Schouten, U. BacherB. N. Savani, J. R. Wingard, H. M. Lazarus, G. G. Laport, S. Montoto, D. G. Maloney, S. M. Smith, C. Brunstein, W. Saber

Research output: Contribution to journalArticle

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Abstract

Alternative donor transplantation is increasingly used for high-risk lymphoma patients. We analyzed 1593 transplant recipients (2000-2010) and compared transplant outcomes in recipients of 8/8 allele HLA-A, -B, -C and DRB1 matched unrelated donors (MUDs; n=1176), 7/8 allele HLA mismatched unrelated donors (MMUDs; n=275) and umbilical cord blood donors (1 or 2 units UCB; n=142). Adjusted 3-year non-relapse mortality of MMUD (44%) was higher as compared with MUD (35%; P=0.004), but similar to UCB recipients (37%; P=0.19), although UCB had lower rates of neutrophil and platelet recovery compared with unrelated donor groups. With a median follow-up of 55 months, 3-year adjusted cumulative incidence of relapse was lower after MMUD compared with MUD (25% vs 33%, P=0.003) but similar between UCB and MUD (30% vs 33%; P=0.48). In multivariate analysis, UCB recipients had lower risks of acute and chronic GVHD compared with adult donor groups (UCB vs MUD: hazard ratio (HR)=0.68, P=0.05; HR=0.35; P<0.001). Adjusted 3-year OS was comparable (43% MUD, 37% MMUD and 41% UCB). These data highlight the observation that patients with lymphoma have acceptable survival after alternative donor transplantation. MMUD and UCB can extend the curative potential of allotransplant to patients who lack suitable HLA matched sibling or MUD.

Original languageEnglish (US)
Pages (from-to)197-203
Number of pages7
JournalBone Marrow Transplantation
Volume50
Issue number2
DOIs
StatePublished - Feb 7 2015

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Unrelated Donors
Lymphoma
Transplantation
Tissue Donors
Alleles
HLA-DRB1 Chains
HLA-A Antigens
HLA-B Antigens
Blood Donors
Fetal Blood
Siblings
Neutrophils
Blood Platelets
Multivariate Analysis
Transplants
Recurrence
Survival
Mortality
Incidence

All Science Journal Classification (ASJC) codes

  • Hematology
  • Transplantation

Cite this

Bachanova, V., Burns, L. J., Wang, T., Carreras, J., Gale, R. P., Wiernik, P. H., ... Saber, W. (2015). Alternative donors extend transplantation for patients with lymphoma who lack an HLA matched donor. Bone Marrow Transplantation, 50(2), 197-203. https://doi.org/10.1038/bmt.2014.259
Bachanova, V. ; Burns, L. J. ; Wang, T. ; Carreras, J. ; Gale, R. P. ; Wiernik, P. H. ; Ballen, K. K. ; Wirk, Baldeep ; Munker, R. ; Rizzieri, D. A. ; Chen, Y. B. ; Gibson, J. ; Akpek, G. ; Costa, L. J. ; Kamble, R. T. ; Aljurf, M. D. ; Hsu, J. W. ; Cairo, M. S. ; Schouten, H. C. ; Bacher, U. ; Savani, B. N. ; Wingard, J. R. ; Lazarus, H. M. ; Laport, G. G. ; Montoto, S. ; Maloney, D. G. ; Smith, S. M. ; Brunstein, C. ; Saber, W. / Alternative donors extend transplantation for patients with lymphoma who lack an HLA matched donor. In: Bone Marrow Transplantation. 2015 ; Vol. 50, No. 2. pp. 197-203.
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abstract = "Alternative donor transplantation is increasingly used for high-risk lymphoma patients. We analyzed 1593 transplant recipients (2000-2010) and compared transplant outcomes in recipients of 8/8 allele HLA-A, -B, -C and DRB1 matched unrelated donors (MUDs; n=1176), 7/8 allele HLA mismatched unrelated donors (MMUDs; n=275) and umbilical cord blood donors (1 or 2 units UCB; n=142). Adjusted 3-year non-relapse mortality of MMUD (44{\%}) was higher as compared with MUD (35{\%}; P=0.004), but similar to UCB recipients (37{\%}; P=0.19), although UCB had lower rates of neutrophil and platelet recovery compared with unrelated donor groups. With a median follow-up of 55 months, 3-year adjusted cumulative incidence of relapse was lower after MMUD compared with MUD (25{\%} vs 33{\%}, P=0.003) but similar between UCB and MUD (30{\%} vs 33{\%}; P=0.48). In multivariate analysis, UCB recipients had lower risks of acute and chronic GVHD compared with adult donor groups (UCB vs MUD: hazard ratio (HR)=0.68, P=0.05; HR=0.35; P<0.001). Adjusted 3-year OS was comparable (43{\%} MUD, 37{\%} MMUD and 41{\%} UCB). These data highlight the observation that patients with lymphoma have acceptable survival after alternative donor transplantation. MMUD and UCB can extend the curative potential of allotransplant to patients who lack suitable HLA matched sibling or MUD.",
author = "V. Bachanova and Burns, {L. J.} and T. Wang and J. Carreras and Gale, {R. P.} and Wiernik, {P. H.} and Ballen, {K. K.} and Baldeep Wirk and R. Munker and Rizzieri, {D. A.} and Chen, {Y. B.} and J. Gibson and G. Akpek and Costa, {L. J.} and Kamble, {R. T.} and Aljurf, {M. D.} and Hsu, {J. W.} and Cairo, {M. S.} and Schouten, {H. C.} and U. Bacher and Savani, {B. N.} and Wingard, {J. R.} and Lazarus, {H. M.} and Laport, {G. G.} and S. Montoto and Maloney, {D. G.} and Smith, {S. M.} and C. Brunstein and W. Saber",
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Bachanova, V, Burns, LJ, Wang, T, Carreras, J, Gale, RP, Wiernik, PH, Ballen, KK, Wirk, B, Munker, R, Rizzieri, DA, Chen, YB, Gibson, J, Akpek, G, Costa, LJ, Kamble, RT, Aljurf, MD, Hsu, JW, Cairo, MS, Schouten, HC, Bacher, U, Savani, BN, Wingard, JR, Lazarus, HM, Laport, GG, Montoto, S, Maloney, DG, Smith, SM, Brunstein, C & Saber, W 2015, 'Alternative donors extend transplantation for patients with lymphoma who lack an HLA matched donor', Bone Marrow Transplantation, vol. 50, no. 2, pp. 197-203. https://doi.org/10.1038/bmt.2014.259

Alternative donors extend transplantation for patients with lymphoma who lack an HLA matched donor. / Bachanova, V.; Burns, L. J.; Wang, T.; Carreras, J.; Gale, R. P.; Wiernik, P. H.; Ballen, K. K.; Wirk, Baldeep; Munker, R.; Rizzieri, D. A.; Chen, Y. B.; Gibson, J.; Akpek, G.; Costa, L. J.; Kamble, R. T.; Aljurf, M. D.; Hsu, J. W.; Cairo, M. S.; Schouten, H. C.; Bacher, U.; Savani, B. N.; Wingard, J. R.; Lazarus, H. M.; Laport, G. G.; Montoto, S.; Maloney, D. G.; Smith, S. M.; Brunstein, C.; Saber, W.

In: Bone Marrow Transplantation, Vol. 50, No. 2, 07.02.2015, p. 197-203.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Alternative donors extend transplantation for patients with lymphoma who lack an HLA matched donor

AU - Bachanova, V.

AU - Burns, L. J.

AU - Wang, T.

AU - Carreras, J.

AU - Gale, R. P.

AU - Wiernik, P. H.

AU - Ballen, K. K.

AU - Wirk, Baldeep

AU - Munker, R.

AU - Rizzieri, D. A.

AU - Chen, Y. B.

AU - Gibson, J.

AU - Akpek, G.

AU - Costa, L. J.

AU - Kamble, R. T.

AU - Aljurf, M. D.

AU - Hsu, J. W.

AU - Cairo, M. S.

AU - Schouten, H. C.

AU - Bacher, U.

AU - Savani, B. N.

AU - Wingard, J. R.

AU - Lazarus, H. M.

AU - Laport, G. G.

AU - Montoto, S.

AU - Maloney, D. G.

AU - Smith, S. M.

AU - Brunstein, C.

AU - Saber, W.

PY - 2015/2/7

Y1 - 2015/2/7

N2 - Alternative donor transplantation is increasingly used for high-risk lymphoma patients. We analyzed 1593 transplant recipients (2000-2010) and compared transplant outcomes in recipients of 8/8 allele HLA-A, -B, -C and DRB1 matched unrelated donors (MUDs; n=1176), 7/8 allele HLA mismatched unrelated donors (MMUDs; n=275) and umbilical cord blood donors (1 or 2 units UCB; n=142). Adjusted 3-year non-relapse mortality of MMUD (44%) was higher as compared with MUD (35%; P=0.004), but similar to UCB recipients (37%; P=0.19), although UCB had lower rates of neutrophil and platelet recovery compared with unrelated donor groups. With a median follow-up of 55 months, 3-year adjusted cumulative incidence of relapse was lower after MMUD compared with MUD (25% vs 33%, P=0.003) but similar between UCB and MUD (30% vs 33%; P=0.48). In multivariate analysis, UCB recipients had lower risks of acute and chronic GVHD compared with adult donor groups (UCB vs MUD: hazard ratio (HR)=0.68, P=0.05; HR=0.35; P<0.001). Adjusted 3-year OS was comparable (43% MUD, 37% MMUD and 41% UCB). These data highlight the observation that patients with lymphoma have acceptable survival after alternative donor transplantation. MMUD and UCB can extend the curative potential of allotransplant to patients who lack suitable HLA matched sibling or MUD.

AB - Alternative donor transplantation is increasingly used for high-risk lymphoma patients. We analyzed 1593 transplant recipients (2000-2010) and compared transplant outcomes in recipients of 8/8 allele HLA-A, -B, -C and DRB1 matched unrelated donors (MUDs; n=1176), 7/8 allele HLA mismatched unrelated donors (MMUDs; n=275) and umbilical cord blood donors (1 or 2 units UCB; n=142). Adjusted 3-year non-relapse mortality of MMUD (44%) was higher as compared with MUD (35%; P=0.004), but similar to UCB recipients (37%; P=0.19), although UCB had lower rates of neutrophil and platelet recovery compared with unrelated donor groups. With a median follow-up of 55 months, 3-year adjusted cumulative incidence of relapse was lower after MMUD compared with MUD (25% vs 33%, P=0.003) but similar between UCB and MUD (30% vs 33%; P=0.48). In multivariate analysis, UCB recipients had lower risks of acute and chronic GVHD compared with adult donor groups (UCB vs MUD: hazard ratio (HR)=0.68, P=0.05; HR=0.35; P<0.001). Adjusted 3-year OS was comparable (43% MUD, 37% MMUD and 41% UCB). These data highlight the observation that patients with lymphoma have acceptable survival after alternative donor transplantation. MMUD and UCB can extend the curative potential of allotransplant to patients who lack suitable HLA matched sibling or MUD.

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