Unrelated and alternative donor allogeneic stem cell transplant in patients with relapsed or refractory Hodgkin lymphoma: a systematic review

Abstract

Allogeneic stem cell transplant (allo-SCT) is considered a clinical option for patients with Hodgkin lymphoma (HL) who have experienced at least two chemosensitive relapses. The aim of this systematic review was to determine the benefits and harms of allo-SCT with an unrelated donor (UD) versus related donor (RD) allo-SCT for adult patients with HL. Alternative donor sources such as haploidentical donor cells (Haplo) and umbilical cord blood (UCB) were also included. The available evidence was limited. Ten studies were included in this assessment. Four studies provided sufficient data to compare UD with RD allo-SCT. None of these studies was a randomized controlled trial. Additionally, three non-comparative studies, such as registry analyses, which considered patients with UD transplants were included. The risk of bias in the studies was high. Results on overall and progression-free survival (PFS) showed no consistent tendency in favor of a donor type. Results on therapy-associated mortality and acute (grade II-IV) and chronic graft-versus-host disease were also inconsistent. The study comparing UCB with RD transplants and two non-comparative studies with UCB transplants showed similar results. One of the studies comparing additionally Haplo with RD transplants indicated a benefit in PFS for the Haplo transplant group. In summary, our findings do not indicate a substantial outcome disadvantage of UD and alternative donor sources versus RD allo-SCT for adult patients with advanced HL.

Improving outcomes after allogeneic hematopoietic cell transplantation for Hodgkin lymphoma in the brentuximab vedotin era

“…40 Our data concur with recent registry data on alternative donor use in patients with lymphoma 41 and a review by Messer et al which indicates that unrelated donor and alternative donor sources versus sibling donor allo SCT result in similar outcomes in advanced HL. 42 …”

Umbilical cord blood transplantation in adults with advanced hodgkin's disease: high incidence of post‐transplant lymphoproliferative disease

“…Earlier studies reported NRM incidences exceeding 50% with myeloablative conditioning allo-SCT (25)(26)(27). Reduced intensity conditionings (RIC) with different hematopoietic stem cell sources including haplo-identical family donors accomplished a reduction of early and long-term NRM of around 15-35% (8,9,22,(28)(29)(30). Nonetheless, no advantage in terms of OS and disease-free survival has been reported, in part due to an increased relapse rate of around 40-63% (4,6,28,31).…”

Indications for allo- and auto-SCT for haematological diseases, solid tumours and immune disorders: current practice in Europe, 2015

“…136,138,139 Accordingly, allo-HSCT can be considered as the standard treatment option in eligible patients with sensitive relapse after auto-HSCT. 140 The value of allo-HSCT is less established in refractory HL, but may be considered in the absence of effective treatment alternatives. 141 Multiple myeloma (MM) Auto-HSCT is clearly indicated for patients less than 70 years of age who respond to first-line treatment.…”