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  • Original Article
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Lymphoma

Haploidentical transplantation with post-infusion cyclophosphamide in advanced Hodgkin lymphoma

A Corrigendum to this article was published on 03 May 2017

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Abstract

We investigated the use of haploidentical hematopoietic stem cell transplantation (haplo-HSCT) in the treatment of advanced Hodgkin lymphoma (HL). Sixty-two consecutive HL patients underwent haplo-HSCT. Unmanipulated stem cells and post-transplant cyclophosphamide were given to all patients as GVHD prophylaxis. At 100 days, the cumulative incidence of grades 2–3 and grades 3–4 acute GVHD was 23% and 4%, respectively. The chronic GVHD (cGVHD) cumulative incidence was 16%, with one patient experiencing severe cGVHD. The 3-year OS, PFS, relapse rates and 1-year non-relapse mortality (NRM) were 63%, 59%, 21% and 20%, respectively. Uncontrolled disease status and high hematopoietic cell transplantation comorbidity index (HCT-CI) were associated with lower OS, whereas PBSC was an independent protective factor. Uncontrolled disease and HCT-CI >2 was predictive for NRM. Finally, disease status other than CR was predictive of relapse. In conclusion, haplo-HSCT is a valid treatment in advanced HL, offering excellent rates of survival and acceptable toxicities.

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  • 03 May 2017

    This article has been corrected since Advance Online Publication and a corrigendum is also printed in this issue.

References

  1. Thomson KJ, Peggs KS, Smith P, Cavet J, Hunter A, Parker A et al. Superiority of reduced-intensity allogeneic transplantation over conventional treatment for relapse of Hodgkin's lymphoma following autologous stem cell transplantation. Bone Marrow Transplant 2008; 41: 765–770.

    Article  CAS  Google Scholar 

  2. Castagna L, Sarina B, Todisco E, Magagnoli M, Balzarotti M, Bramanti S et al. Allogeneic stem cell transplantation compared with chemotherapy for poor-risk Hodgkin lymphoma. Biol Blood Marrow Transplant 2009; 15: 432–438.

    Article  CAS  Google Scholar 

  3. Robinson SP, Sureda A, Canals C, Russell N, Caballero D, Bacigalupo A et al. Reduced intensity conditioning allogeneic stem cell transplantation for Hodgkin's lymphoma: identification of prognostic factors predicting outcome. Haematologica 2009; 94: 230–238.

    Article  Google Scholar 

  4. Sarina B, Castagna L, Farina L, Patriarca F, Benedetti F, Carella AM et al. Allogeneic transplantation improves the overall and progression-free survival of Hodgkin lymphoma patients relapsing after autologous transplantation: a retrospective study based on the time of HLA typing and donor availability. Blood 2010; 115: 3671–3677.

    Article  CAS  Google Scholar 

  5. Sureda A, Canals C, Arranz R, Caballero D, Ribera JM, Brune M et al. Allogeneic stem cell transplantation after reduced intensity conditioning in patients with relapsed or refractory Hodgkin's lymphoma. Results of the HDR-ALLO study- a prospective clinical trial by the Grupo Español de Linfomas/Trasplante de Médula Osea (GEL/TAMO) and the Lymphoma Working Party of the European Group for Blood and Marrow Transplantation. Haematologica 2012; 97: 310–317.

    Article  Google Scholar 

  6. Messer M, Steinzen A, Vervölgyi E, Lerch C, Richter B, Dreger P et al. Unrelated and alternative donor allogeneic stem cell transplant in patients with relapsed or refractory Hodgkin lymphoma: a systematic review. Leuk Lymphoma 2014; 55: 296–306.

    Article  CAS  Google Scholar 

  7. Luznik L, O'Donnell PV, Symons HJ, Chen AR, Leffell MS, Zahurak M et al. HLA-haploidentical bone marrow transplantation for hematologic malignancies using nonmyeloablative conditioning and high-dose, posttransplantation cyclophosphamide. Biol Blood Marrow Transplant 2008; 14: 641–650.

    Article  CAS  Google Scholar 

  8. Burroughs LM, O'Donnell PV, Sandmaier BM, Storer BE, Luznik L, Symons HJ et al. Comparison of outcomes of HLA-matched related, unrelated, or HLA-haploidentical related hematopoietic cell transplantation following nonmyeloablative conditioning for relapsed or refractory Hodgkin lymphoma. Biol Blood Marrow Transplant 2008; 14: 1279–1287.

    Article  Google Scholar 

  9. Raiola A, Dominietto A, Varaldo R, Ghiso A, Galaverna F, Bramanti S et al. Unmanipulated haploidentical BMT following non-myeloablative conditioning and post-transplantation CY for advanced Hodgkin's lymphoma. Bone Marrow Transplant 2014; 49: 190–194.

    Article  CAS  Google Scholar 

  10. Sorror ML, Maris MB, Storb R, Baron F, Sandmaier BM, Maloney DG et al. Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. Blood 2005; 106: 2912–2919.

    Article  CAS  Google Scholar 

  11. Castagna L, Crocchiolo R, Furst S, Bramanti S, El Cheikh J, Sarina B et al. Bone marrow compared with peripheral blood stem cells for haploidentical transplantation with a nonmyeloablative conditioning regimen and post-transplantation cyclophosphamide. Biol Blood Marrow Transplant 2014; 20: 724–729.

    Article  Google Scholar 

  12. Przepiorka D, Weisdorf D, Martin P, Klingemann HG, Beatty P, Hows J et al1994 Consensus conference on acute GVHD grading. Bone Marrow Transplant 1995; 15: 825–828.

    Google Scholar 

  13. Filipovich AH, Weisdorf D, Pavletic S, Socie G, Wingard JR, Lee SJ et al. National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. Diagnosis and staging working group report. Biol Blood Marrow Transplant 2005; 11: 945–956.

    Article  Google Scholar 

  14. Gooley TA, Leisenring W, Crowley J, Storer BE . Estimation of failure probabilities in the presence of competing risks: new representations of old estimators. Stat Med 1999; 18: 695–706.

    Article  CAS  Google Scholar 

  15. Kaplan EL, Meier P . Non-parametric estimation from incomplete observations. J Am Stat Assoc 1958; 53: 457–481.

    Article  Google Scholar 

  16. Cox D . Regression models and life tables. J R Stat Soc (B) 1972; 34: 187–220.

    Google Scholar 

  17. Kanate AS, Mussetti A, Kharfan-Dabaja MA, Ahn KW, DiGilio A, Beitinjaneh A et al. Reduced-intensity transplantation for lymphomas using haploidentical related donors vs HLA-matched unrelated donors. Blood 2016; 127: 938–947.

    Article  CAS  Google Scholar 

  18. Ghosh N, Karmali R, Rocha V, Ahn KW, DiGilio A, Hari PN et al. Reduced-intensity transplantation for lymphomas using haploidentical related donors versus HLA-matched sibling donors: a Center for International Blood and Marrow Transplant Research Analysis. J Clin Oncol 2016; 34: 3141–3149 pii: JCO663476.

    Article  CAS  Google Scholar 

  19. Younes A, Gopal AK, Smith SE, Ansell SM, Rosenblatt JD, Savage KJ et al. Results of a pivotal phase II study of brentuximab vedotin for patients with relapsed or refractory Hodgkin's lymphoma. J Clin Oncol 2012; 30: 2183–2189.

    Article  CAS  Google Scholar 

  20. Gopal AK, Chen R, Smith SE, Ansell SM, Rosenblatt JD, Savage KJ et al. Durable remissions in a pivotal phase 2 study of brentuximab vedotin in relapsed or refractory Hodgkin lymphoma. Blood 2015; 125: 1236–1243.

    Article  CAS  Google Scholar 

  21. Ansell SM, Lesokhin AM, Borrello I, Halwani A, Scott EC, Gutierrez M et al. PD-1 blockade with nivolumab in relapsed or refractory Hodgkin's lymphoma. N Engl J Med 2015; 372: 311–319.

    Article  Google Scholar 

  22. Moskowitz CH, Ribrag V, Michot JM . PD-1 blockade with the monoclonal antibody pembrolizumab (MK-3475) in patients with classical Hodgkin lymphoma after brentuximab vedotin failure: preliminary results from a phase 1b study (KEYNOTE-013). Blood 2014; 124: 290.

    Google Scholar 

  23. Stem Cell Trialists . Collaborative Group. Allogeneic peripheral blood stem-cell compared with bone marrow transplantation in the management of hematologic malignancies: an individual patient data meta-analysis of nine randomized trials. J Clin Oncol 2005; 23: 5074–5087.

    Article  Google Scholar 

  24. Bashey A, Zhang X, Sizemore CA, Manion K, Brown S, Holland HK et al. T-cell-replete HLA-haploidentical hematopoietic transplantation for hematologic malignancies using post-transplantation cyclophosphamide results in outcomes equivalent to those of contemporaneous HLA-matched related and unrelated donor transplantation. J Clin Oncol 2013; 31: 1310–1316.

    Article  CAS  Google Scholar 

  25. McCurdy SR, Kanakry JA, Showel MM, Tsai HL, Bolaños-Meade J, Rosner GL et al. Risk-stratified outcomes of nonmyeloablative HLA-haploidentical BMT with high-dose posttransplantation cyclophosphamide. Blood 2015; 125: 3024–3031.

    Article  CAS  Google Scholar 

  26. Robinson SP, Goldstone AH, Mackinnon S, Carella A, Russell N, de Elvira CR et al. Chemoresistant or aggressive lymphoma predicts for a poor outcome following reduced-intensity allogeneic progenitor cell transplantation: an analysis from the Lymphoma Working Party of the European Group for Blood and Bone Marrow Transplantation. Blood 2002; 100: 4310–4316.

    Article  CAS  Google Scholar 

  27. Peggs KS, Hunter A, Chopra R, Parker A, Mahendra P, Milligan D et al. Clinical evidence of a graft-versus-Hodgkin's-lymphoma effect after reduced-intensity allogeneic transplantation. Lancet 2005; 365: 1934–1941.

    Article  Google Scholar 

  28. Alvarez I, Sureda A, Caballero MD, Urbano-Ispizua A, Ribera JM, Canales M et al. Nonmyeloablative stem cell transplantation is an effective therapy for refractory or relapsed Hodgkin lymphoma: results of a spanish prospective cooperative protocol. Biol Blood Marrow Transplant 2006; 12: 172–183.

    Article  Google Scholar 

  29. Todisco E, Castagna L, Sarina B, Mazza R, Anastasia A, Balzarotti M et al. Reduced-intensity allogeneic transplantation in patients with refractory or progressive Hodgkin's disease after high-dose chemotherapy and autologous stem cell infusion. Eur J Haematol 2007; 78: 322–329.

    Article  CAS  Google Scholar 

  30. Corradini P, Dodero A, Farina L, Fanin R, Patriarca F, Miceli R et al. Allogeneic stem cell transplantation following reduced-intensity conditioning can induce durable clinical and molecular remissions in relapsed lymphomas: pre-transplant disease status and histotype heavily influence outcome. Leukemia 2007; 21: 2316–2323.

    Article  CAS  Google Scholar 

  31. Anderlini P, Saliba R, Acholonu S, Giralt SA, Andersson B, Ueno NT et al. Fludarabine-melphalan as a preparative regimen for reduced-intensity conditioning allogeneic stem cell transplantation in relapsed and refractory Hodgkin's lymphoma: the updated M.D. Anderson Cancer Center experience. Haematologica 2008; 93: 257–264.

    Article  CAS  Google Scholar 

  32. Devetten MP, Hari PN, Carreras J, Logan BR, van Besien K, Bredeson CN et al. Unrelated donor reduced-intensity allogeneic hematopoietic stem cell transplantation for relapsed and refractory Hodgkin lymphoma. Biol Blood Marrow Transplant 2009; 15: 109–117.

    Article  Google Scholar 

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Correspondence to L Castagna.

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Castagna, L., Bramanti, S., Devillier, R. et al. Haploidentical transplantation with post-infusion cyclophosphamide in advanced Hodgkin lymphoma. Bone Marrow Transplant 52, 683–688 (2017). https://doi.org/10.1038/bmt.2016.348

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