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; B. 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. Bacher; B. N. Savani; J. R. Wingard; H. M. Lazarus; G. G. Laport; S. Montoto; D. G. Maloney; S. M. Smith; C. Brunstein; W. Saber

doi:10.1038/bmt.2014.259

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, B. 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

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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 language	English
Pages (from-to)	197-203
Journal	Bone Marrow Transplantation
Volume	50
Issue number	2
DOIs	https://doi.org/10.1038/bmt.2014.259
Publication status	Published - Feb 2015

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10.1038/bmt.2014.259

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Bachanova, V., Burns, L. J., Wang, T., Carreras, J., Gale, R. P., Wiernik, P. H., Ballen, K. K., Wirk, B., 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., ... 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

@article{3121e77c4d3842cdba83f9d0840a8e0b,

title = "Alternative donors extend transplantation for patients with lymphoma who lack an HLA matched donor",

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 B. Wirk and R. Munker and Rizzieri, {D. A.} and Y-B Chen 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",

year = "2015",

month = feb,

doi = "10.1038/bmt.2014.259",

language = "English",

volume = "50",

pages = "197--203",

journal = "Bone Marrow Transplantation",

issn = "0268-3369",

publisher = "Nature Publishing Group",

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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, Y-B, 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

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, B.

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

Y1 - 2015/2

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.

U2 - 10.1038/bmt.2014.259

DO - 10.1038/bmt.2014.259

M3 - Article

C2 - 25402415

SN - 0268-3369

VL - 50

SP - 197

EP - 203

JO - Bone Marrow Transplantation

JF - Bone Marrow Transplantation

IS - 2

ER -