Patients with Hodgkin's lymphoma have similar survival outcomes for the three transplant regimens
Spanish researcher Carmen Martínez et al. reported that compared with patients with Hodgkin’s lymphoma who received sibling HLA-matched donor transplantation and HLA-matched unrelated donor transplantation, cyclophosphamide-based haploidentical (HAPLO) allogeneic hematopoiesis was obtained after transplantation. Patients with stem cell transplantation have similar survival outcomes, which confirms the applicability of the program when traditional donors are not available. In addition, HAPLO transplantation has a lower risk of chronic graft-versus-host disease (GVHD) than transplantation from unrelated donors. (J Clin Oncol. Online version August 28, 2017)
The study was based on 709 adult Hodgkin lymphoma patients enrolled in the database of the European Society for Blood and Bone Marrow Transplantation, including those of HAPLO allogeneic hematopoietic stem cell transplantation based on cyclophosphamide after transplantation. There were 98 patients, 338 patients who received traditional sibling HLA-matched donor (SIB) transplantation and 273 patients who received HLA-matched unrelated donor (MUD) transplantation. The outcome of the former was compared with the latter in a retrospective analysis.
The results showed that at a median follow-up of 29 months, there was no difference in the incidence of acute GVHD between the two groups. Compared with MUD transplant patients, HAPLO transplant patients have a lower risk of chronic GVHD (26% vs. 41%, P=0.04). The 1-year cumulative non-relapse mortality rates of HAPLO transplant patients, SIB transplant patients, and MUD transplant patients were 17%, 13%, and 21%, respectively, and the corresponding 2-year cumulative incidence of recurrence or disease progression was 39%, 49%, and 32, respectively. %.
In the multivariate analysis, the non-recurring mortality of HAPLO transplant patients was similar to that of SIB transplant patients (P=0.26), but it was higher in MUD transplant patients (P=0.003). Both HAPLO transplant patients (P=0.047) and MUD transplant patients (P<0.001) had a lower risk of recurrence. The 2-year overall survival rate and progression-free survival rate of HAPLO transplant patients were 67% and 43%, respectively, SIB transplant patients were 71% and 38%, and MUD transplant patients were 62% and 45%, respectively.
There was no significant difference in overall survival or progression-free survival between HAPLO transplantation group and SIB transplantation group or MUD transplantation group. The composite endpoint and recurrence-free survival rate of HAPLO transplant patients were significantly better than those of SIB transplant patients (40% vs 28%, P=0.049), which was similar to MUD transplant patients (38%, P=0.59).
