Alternative donors extend transplantation for patients with lymphoma who lack an HLA matched donor

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.