TY - JOUR
T1 - Outcomes of Advanced Hodgkin Lymphoma after Umbilical Cord Blood Transplantation
T2 - A Eurocord and EBMT Lymphoma and Cellular Therapy & Immunobiology Working Party Study
AU - Paviglianiti, Annalisa
AU - Maio, Karina Tozatto
AU - Rocha, Vanderson
AU - Gehlkopf, Eve
AU - Milpied, Noel
AU - Esquirol, Albert
AU - Chevallier, Patrice
AU - Blaise, Didier
AU - Gac, Anne-Claire
AU - Leblond, Veronique
AU - Cahn, Jean Yves
AU - Abecasis, Manuel
AU - Zuckerman, Tsila
AU - Schouten, Harry
AU - Gurman, Gunhan
AU - Rubio, Marie Therese
AU - Beguin, Yves
AU - Corral, Lucia
AU - Nagler, Arnon
AU - Snowden, John A.
AU - Koc, Yener
AU - Mordini, Nicola
AU - Bonifazi, Francesca
AU - Volt, Fernanda
AU - Kenzey, Chantal
AU - Robinson, Stephen Paul
AU - Montoto, Silvia
AU - Gluckman, Eliane
AU - Ruggeri, Annalisa
PY - 2018/11/1
Y1 - 2018/11/1
N2 - Allogeneic stem cell transplantation is an alternative for patients with relapsed or refractory Hodgkin lymphoma (HL), but only limited data on unrelated umbilical cord blood transplantation (UCBT) are available. We analyzed 131 adults with HL who underwent UCBT in European Society for Blood and Marrow Transplantation centers from 2003 to 2015. Disease status at UCBT was complete remission (CR) in 59 patients (47%), and almost all patients had received a previous autologous stem cell transplantation. The 4-year progression-free survival (PFS) and overall survival (OS) were 26% (95% confidence interval [CI], 19% to 34%) and 46% (95% CI, 37% to 55%), respectively. Relapse incidence was 44% (95% CI, 36% to 54%), and nonrelapse mortality (NRM) was 31% (95% CI, 23% to 40%) at 4 years. In multivariate analysis refractory/relapsed disease status at UCBT was associated with increased relapse incidence (hazard ratio [HA], 3.14 [95% CI, 1.41 to 7.00], P = .005) and NRM (HR, 3.61 [95% CI, 1.58 to 827], P = .002) and lower PFS (HR, 3.45 [95% CI, 1.95 to 6.10], P < .001) and OS (HR, 3.10 [95% CI, 1.60 to 5.99], P= .001). Conditioning regimen with cyclophosphamide + fludarabine + 2 Gy total body irradiation (Cy+Flu+2GyTBI) was associated with decreased risk of NRM (HR, .26 [95% CI, .10 to .64], P = .004). Moreover, Cy+Flu+2GyTBI conditioning regimen was associated with a better OS (HR, .25 [95% CI, .12 to .50], P < .001) and PFS (HR, .51 [95% CI, .27 to .96], P = .04). UCBT is feasible in heavily pretreated patients with HL The reduced-intensity conditioning regimen with Cy+Flu+2GyTBI is associated with a better OS and NRM. However, outcomes are poor in patients not in CR at UCBT. (C) 2018 American Society for Blood and Marrow Transplantation.
AB - Allogeneic stem cell transplantation is an alternative for patients with relapsed or refractory Hodgkin lymphoma (HL), but only limited data on unrelated umbilical cord blood transplantation (UCBT) are available. We analyzed 131 adults with HL who underwent UCBT in European Society for Blood and Marrow Transplantation centers from 2003 to 2015. Disease status at UCBT was complete remission (CR) in 59 patients (47%), and almost all patients had received a previous autologous stem cell transplantation. The 4-year progression-free survival (PFS) and overall survival (OS) were 26% (95% confidence interval [CI], 19% to 34%) and 46% (95% CI, 37% to 55%), respectively. Relapse incidence was 44% (95% CI, 36% to 54%), and nonrelapse mortality (NRM) was 31% (95% CI, 23% to 40%) at 4 years. In multivariate analysis refractory/relapsed disease status at UCBT was associated with increased relapse incidence (hazard ratio [HA], 3.14 [95% CI, 1.41 to 7.00], P = .005) and NRM (HR, 3.61 [95% CI, 1.58 to 827], P = .002) and lower PFS (HR, 3.45 [95% CI, 1.95 to 6.10], P < .001) and OS (HR, 3.10 [95% CI, 1.60 to 5.99], P= .001). Conditioning regimen with cyclophosphamide + fludarabine + 2 Gy total body irradiation (Cy+Flu+2GyTBI) was associated with decreased risk of NRM (HR, .26 [95% CI, .10 to .64], P = .004). Moreover, Cy+Flu+2GyTBI conditioning regimen was associated with a better OS (HR, .25 [95% CI, .12 to .50], P < .001) and PFS (HR, .51 [95% CI, .27 to .96], P = .04). UCBT is feasible in heavily pretreated patients with HL The reduced-intensity conditioning regimen with Cy+Flu+2GyTBI is associated with a better OS and NRM. However, outcomes are poor in patients not in CR at UCBT. (C) 2018 American Society for Blood and Marrow Transplantation.
KW - Hodgkin lymphoma
KW - Umbilical cord blood transplantation
KW - Adult patients
KW - BONE-MARROW-TRANSPLANTATION
KW - VERSUS-HOST-DISEASE
KW - BRENTUXIMAB VEDOTIN
KW - REDUCED-INTENSITY
KW - ALLOGENEIC TRANSPLANTATION
KW - HAPLOIDENTICAL TRANSPLANTATION
KW - FRENCH SOCIETY
KW - EUROPEAN GROUP
KW - PD-1 BLOCKADE
KW - SINGLE-ARM
U2 - 10.1016/j.bbmt.2018.07.019
DO - 10.1016/j.bbmt.2018.07.019
M3 - Article
C2 - 30031070
SN - 1083-8791
VL - 24
SP - 2265
EP - 2270
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 11
ER -