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

Sairah Ahmed, Jennifer A. Kanakry, Kwang W. Ahn, Carlos Litovich, Hisham Abdel-Azim, Mahmoud Aljurf, Vera Ulrike Bacher, Nelli Bejanyan, Jonathon B. Cohen, Umar Farooq, Ephraim J. Fuchs, Javier Bolaños-Meade, Nilanjan Ghosh, Alex F. Herrera, Nasheed M. Hossain, David Inwards, Abraham S. Kanate, Rodrigo Martino, Pashna N. Munshi, Hemant MurthyAlberto Mussetti, Yago Nieto, Miguel Angel Perales, Rizwan Romee, Bipin N. Savani, Sachiko Seo, Baldeep Wirk, Jean A. Yared, Ana Sureda, Timothy S. Fenske, Mehdi Hamadani

Research output: Contribution to journalArticlepeer-review

22 Scopus citations

Abstract

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) HCT 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% CI, .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% CI, .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.

Original languageEnglish (US)
Pages (from-to)1859-1868
Number of pages10
JournalBiology of Blood and Marrow Transplantation
Volume25
Issue number9
DOIs
StatePublished - Sep 2019

All Science Journal Classification (ASJC) codes

  • Hematology
  • Transplantation

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