Abstract
Introductionhaploidentical stem cell transplantation (SCT) represents an alternative option for those patients lacking a HLA-identical donor. Patients with relapsed or refractory Hodgkin's lymphoma may benefit from allogeneic SCT and, in particular, patients without a HLA-identical donor may receive SCT from a haploidentical one. The aim of this retrospective analysis is to compare outcome of HL patients undergoing allogeneic SCT from haploidentical vs. HLA-id. Donor. Methodspatients with diagnosis of HL who received allogeneic SCT at Istituto Clinico Humanitas (Milan, Italy) and Institut Paoli-Calmettes (Marseille, France) were included in the analysis. Outcome was estimated according to SC source (HLA-id. vs. haplo) and disease status at transplant: CR, PR or SP/PD. Resultsa total of 58 and 36 patients received SCT from a HLA-id. and haploidentical donor, respectively. SCT were performed from February 1999 to December 2012. Ninety-two patients received reduced-intensity conditioning; all but one patient in haplo group received post-transplant cyclophosphamide as GVHD prophylaxis. Median follow-up was 63 months (range: 6-160) in HLA-id. group and 20 months (range: 6-50) in haplo group. In HLA-id. group, 2-year PFS was 62%, 33% and 17% among patients in CR, PR or SD/PD before allogeneic SCT, respectively; 2-year PFS in haplo patients was 86%, 53% and 0% among CR, PR and SD/PD patients. Results are shown in Table 1. Notably, a lower number of relapse events were observed in chemosensitive patients in haplo group compared with HLA-id.: 1/21 vs. 7/28 among CR patients and 2/9 vs. 10/18 among those in PR (see Table 1); this translates into better PFS after haplo-SCT. Conversely, outcome of refractory patients confirmed to be poor in both groups. At last follow-up, among the 30 chemosensitive patients receiving haplo-SCT, last relapse occurred at day +392 post-SCT.Table 1Outcome according to donor source and pre-transplant disease statusDisease status pre-SCT (% of total)CR, n= 49 (52%)PR, n= 27 (29%)SD/PD, n= 18 (19%)SC sourcehaplo, n=21HLA-id., n=28haplo, n=9HLA-id., n=18haplo, n=6HLA-id., n=12Relapse events (rate)1 (5%)7 (25%)2 (22%)10 (55%)2 (33%)8 (67%)2-y OS (95% CI)84% (73-99)88% (76-100)65% (33-97)43% (19-57)33% (0-71)50% (21-79)2-y PFS (95% CI)86% (71-100)62% (44-80)53% (20-86)33% (11-55)0%17% (0-39) Conclusionspresent analysis showed better PFS in haplo group among high-risk, chemosensitive (CR + PR) patients compared with HLA-id. and better OS among patients who were in PR before SCT; this was due to lower relapse rate among chemosensitive patients after haplo-SCT vs. HLA-id. In conclusion, haplo-SCT showed high antitumor activity, leading to promising outcome of chemosensitive patients compared with HLA-id transplants. Present data may challenge donor choice in this subset of patients, who may benefit from graft-versus-lymphoma effect, potentially enhanced by haplo disparity. Disclosures:No relevant conflicts of interest to declare.
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