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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. Seo
  • M.A. Kharfan-Dabaja, A. Sureda, T.S. Fenske, M. Hamadani*
*Corresponding author for this work

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

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 <0·01. There were no significant differences between regimens in risk for non-relapse mortality (NRM) (P = 0·54), relapse/progression (P = 0·02) or progression-free survival (PFS) (P = 0·14). Flu/Cy conditioning was associated with decreased risk of mortality in the first 11 months after allo-HCT (HR = 0·28; 95% CI = 0·10–0·73; P = 0·009), but beyond 11 months post allo-HCT it was associated with a significantly higher risk of mortality, (HR = 2·46; 95% CI = 0·1.32–4·61; P = 0·005). 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 = 0·64), 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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