Abstract
BackgroundAllogeneic stem cell transplantation from haploidentical donor using an unmanipulated graft and post-transplantation cyclophosphamide (PT-Cy) is growing. Haploidentical transplantation with PT-Cy showed a major activity in Hodgkin lymphoma (HL), reducing the relapse incidence. The most important predictive factor of survival and toxicity was disease status before transplantation, which was better in patients with well controlled disease.MethodsWe included 198 HL in complete (CR) or partial remission (PR) before transplantation. Sixty-five patients were transplanted from haploidentical donor and 133 from a HLA identical donor (both sibling and unrelated donors). Survival analysis was defined according to the EBMT criteria. Survival curves were generated by using Kaplan-Meier method and differences between groups were compared by the log rank test or by the log rank test for trend when appropriated.ResultsThe PFS, OS, and RI were significantly better in patients in CR compared to PR (55% vs 29% p = 0.001, 74% vs 55% p = 0.03, 27% vs 55% p < 0.001, respectively). The 2-year PFS was significantly better for HAPLO than HLA-id (63% vs 37%, p = 0.03), without difference in OS. The 1-year NRM was not different. The 2-year relapse incidence (RI) was lower in the HAPLO group (24% vs 44%, p = 0.008). Patients in CR receiving haplo HSCT showed higher 2-year PFS and lower 2-year RI than those allografted with HLA-id donor (75% vs 47%, p < 0.001 and 11% vs 34%, p < 0.001, respectively). In multivariate analysis, donor type and disease status before transplantation were independent predictors of PFS as well as they predict the risk of relapse. Disease status at transplantation and age were independently associated to OS.ConclusionsNonetheless this is a retrospective study, limiting the wide applicability of results, data from this analysis suggest that HLA mismatch can induce a strong graft versus lymphoma effect leading to an enhanced PFS.
Highlights
Allogeneic stem cell transplantation from haploidentical donor using an unmanipulated graft and post-transplantation cyclophosphamide (PT-Cy) is growing
Conclusions: this is a retrospective study, limiting the wide applicability of results, data from this analysis suggest that HLA mismatch can induce a strong graft versus lymphoma effect leading to an enhanced progression-free survival (PFS)
In a retrospective study on patients with Hodgkin lymphoma (HL), the relapse risk was decreased in patients grafted from a haploidentical (HAPLO) donor, compared patients grafted from HLA identical sibling (SIBS) or unrelated donors (UD), with a 2-year progression-free survival (PFS), of 51% for HAPLO versus 23% for SIBS and 29% for UD donors [7]
Summary
Allogeneic stem cell transplantation from haploidentical donor using an unmanipulated graft and post-transplantation cyclophosphamide (PT-Cy) is growing. In a retrospective study on patients with HL, the relapse risk was decreased in patients grafted from a haploidentical (HAPLO) donor, compared patients grafted from HLA identical sibling (SIBS) or unrelated donors (UD), with a 2-year progression-free survival (PFS), of 51% for HAPLO versus 23% for SIBS and 29% for UD donors [7]. These results suggested a peculiar immunological graft-versus tumor effect of HAPLO donors against HL cells [8,9,10]. We are reporting a comparative analysis of 198 patients with HL with chemosensitive disease receiving allo-HSCT from SIBS/ MUD, or HAPLO donor
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