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 to 2010) and compared transplant outcomes in recipients of 8/8 allele human leukocyte antigen (HLA)-A, -B, -C, and DRB1 matched unrelated donors (MUD; n=1176), 7/8 allele HLA-matched unrelated donors (MMUD; 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 to 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 to 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 graft versus host disease compared with adult donor groups (UCB vs MUD: HR=0.68, p=0.05; HR=0.35; p<0.001). Adjusted 3-year overall survival was comparable (43% MUD, 37% MMUD and 41% UCB). Data highlight that patients with lymphoma have acceptable survival after alternative donor transplantation. MMUD and UCB can expand the curative potential of allotransplant to patients who lack suitable HLA-matched sibling or MUD.

Umbilical cord blood donation: public or private?

“…43 A study of 1593 lymphoma patients found similar overall among UCBT, 8/8 allele-matched unrelated bone marrow transplant and 7/8 allele-matched unrelated bone marrow transplant. 44 Chen et al 45 described similar disease-free survival among patients treated with RIC receiving either double UCBT or matched unrelated donor PBSC transplants at a single center. Results with haploidentical transplant continue to improve with the use of post transplant cyclophosphamide, pioneered at Johns Hopkins.…”

Allogeneic Hematopoietic Cell Transplantation as Curative Therapy for Patients with Non-Hodgkin Lymphoma: Increasingly Successful Application to Older Patients

“…In recent years, alternative donor transplantation (umbilical cord blood or haploidentical marrow) has become more widespread, with recent publications showing outcomes that compare favorably to those using matched unrelated donors. [78,79] The haploidentical approach, with post-transplant cyclophosphamide, has successfully been applied to lymphoma patients up to age 75, with 1 year NRM of 10–15% across all age groups from 50–75, and a 3 year survival of approximately 50%. [80] With the growing use and success of alternative donor transplantation, it is expected that an even larger number of older patients will be allo-HCT candidates, since in many cases such patients do not have a matched sibling who is in good enough health to serve as a donor.…”

Impact of Pretransplantation 18F-fluorodeoxy Glucose–Positron Emission Tomography Status on Outcomes after Allogeneic Hematopoietic Cell Transplantation for Non-Hodgkin Lymphoma

“…Allogeneic hematopoietic cell transplantation (HCT) can provide long-term survival for patients with various subtypes of lymphoma; however, relapse remains the predominant cause of treatment failure [1-4]. The use of 18 F-fluorodeoxy glucose (FDG)-positron emission tomography (PET) after front-line or salvage chemotherapy is a valuable prognostic tool to assess the depth of remission before autologous HCT [5-9].…”