Impact of type of reduced-intensity conditioning regimen on the outcomes of allogeneic haematopoietic cell transplantation in classical Hodgkin lymphoma

S. Ahmed, N. Ghosh, K.W. Ahn, M. Khanal, C. Litovich, A. Mussetti, S. Chhabra, M. Cairo, M. Mei, B. William, S. Nathan, N. Bejanyan, R.F. Olsson, P.B. Dahi, M. van der Poel, A. Steinberg, J. Kanakry, J. Cerny, U. Farooq, S. SeoM.A. Kharfan-Dabaja, A. Sureda, T.S. Fenske, M. Hamadani*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Reduced-intensity conditioning (RIC) allogeneic haematopoietic cell transplantation (allo-HCT) is a curative option for select relapsed/refractory Hodgkin lymphoma (HL) patients; however, there are sparse data to support superiority of any particular conditioning regimen. We analyzed 492 adult patients undergoing human leucocyte antigen (HLA)-matched sibling or unrelated donor allo-HCT for HL between 2008 and 2016, utilizing RIC with either fludarabine/busulfan (Flu/Bu), fludarabine/melphalan (Flu/Mel140) or fludarabine/cyclophosphamide (Flu/Cy). Multivariable regression analysis was performed using a significance level of <0 center dot 01. There were no significant differences between regimens in risk for non-relapse mortality (NRM) (P = 0 center dot 54), relapse/progression (P = 0 center dot 02) or progression-free survival (PFS) (P = 0 center dot 14). Flu/Cy conditioning was associated with decreased risk of mortality in the first 11 months after allo-HCT (HR = 0 center dot 28; 95% CI = 0 center dot 10-0 center dot 73; P = 0 center dot 009), but beyond 11 months post allo-HCT it was associated with a significantly higher risk of mortality, (HR = 2 center dot 46; 95% CI = 0 center dot 1.32-4 center dot 61; P = 0 center dot 005). Four-year adjusted overall survival (OS) was similar across regimens at 62% for Flu/Bu, 59% for Flu/Mel140 and 55% for Flu/Cy (P = 0 center dot 64), respectively. These data confirm the choice of RIC for allo-HCT in HL does not influence risk of relapse, NRM or PFS. Although no OS benefit was seen between Flu/Bu and Flu/Mel 140; Flu/Cy was associated with a significantly higher risk of mortality beyond 11 months from allo-HCT (possibly due to late NRM events).
Original languageEnglish
Pages (from-to)573-582
Number of pages10
JournalBritish Journal of Haematology
Volume190
Issue number4
DOIs
Publication statusPublished - 1 Aug 2020

Keywords

  • allogeneic hematopoietic cell transplant
  • blood
  • chronic graft
  • classical hodgkin lymphoma
  • disease
  • european group
  • haploidentical transplantation
  • pd-1 blockade
  • posttransplantation cyclophosphamide
  • prognostic-factors
  • reduced-intensity conditioning
  • therapy
  • working party
  • PROGNOSTIC-FACTORS
  • PD-1 BLOCKADE
  • classical Hodgkin lymphoma
  • EUROPEAN GROUP
  • CHRONIC GRAFT
  • WORKING PARTY
  • THERAPY
  • POSTTRANSPLANTATION CYCLOPHOSPHAMIDE
  • HAPLOIDENTICAL TRANSPLANTATION
  • DISEASE
  • BLOOD

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