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Post-transplant cyclophosphamide-based haplo-identical transplantation as alternative to matched sibling or unrelated donor transplantation for non-Hodgkin lymphoma: a registry study by the European society for blood and marrow transplantation

Leukemia volume 30, pages 2086–2089 (2016)Cite this article

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Allogeneic hematopoietic stem cell transplantation (alloSCT) is a valuable treatment option with curative potential for patients with relapsed and refractory non-Hodgkin's lymphoma (NHL),1 but its use has been limited by matched donor availability. Haplo-identical stem cell transplantation (haplo-SCT) has been developed to address this limitation. Virtually all patients have a haplotype-mismatched family donor, who is immediately available. The recent development of haplo-SCT protocols, involving high-dose post-transplant cyclophosphamide (ptCY) given early after graft infusion2 has led to a continuously growing popularity of haplo-SCT. Although the data in myeloid diseases and Hodgkin’s lymphoma is accumulating,3 specific information on the efficacy of haplo-SCT in NHL is still scanty. Therefore, we conducted a retrospective study using the European society for blood and marrow transplantation registry to compare the outcome of patients with NHL, who have undergone haplo-SCT followed by ptCY with those allografted from matched related or unrelated donors.

Data for patients older than 18 years who had undergone alloSCT for mantle cell lymphoma, diffuse large B-cell lymphoma (DLBCL), T-cell lymphoma (TCL) and follicular lymphoma (FL) between 2007 and 2013 was downloaded from the European society for blood and marrow transplantation registry. Haplo-SCT was defined as transplant from a mismatched related donor (⩾2 mismatches). Co-primary end points studied were overall survival (OS) and progression-free survival (PFS). OS was defined as the time from alloSCT to death from any cause, and PFS was defined as the time from alloSCT to relapse or progressive disease or death from any cause, whatever came first. Probabilities of OS were calculated using the Kaplan–Meier estimate and compared using the log-rank test. Multivariate comparisons of OS times and estimations of hazard ratios were calculated using Cox regression models. Multivariate analyses were performed as complete case analysis. Secondary end points were incidence of disease relapse or progression (RI) and non-relapse mortality (NRM), and incidences of acute GVHD and chronic graft-versus-host disease (cGVHD). RI after alloSCT was calculated as time from alloSCT to relapse or progression, and NRM was calculated as time from alloSCT to death in the absence of prior relapse or progression. Relapse and NRM events were considered as competing risks. For cumulative incidence of cGVHD, relapse was considered as a competing risk. Cumulative incidence curves for relapse, cGVHD and NRM incidences were compared using the Gray’s test.4, 5 Multivariate analyses for relapse and NRM incidences were performed using a competing risk proportional subdistribution hazards regression model.4, 5

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Acknowledgements

SD was supported by a grant of the Heidelberg Research Centre for Molecular Medicine (HRCMM).

Author contributions

SD, AS, SR and PD designed the research, interpreted data, contributed data and wrote the manuscript; SD and AB performed the statistical analysis; HF collected the data; and CM, JT, DB, PC, LC, NM, AB, PC, MM, MS, AH and SM contributed the data and helped writing the manuscript.

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Authors and Affiliations

  1. Department of Medicine V, University of Heidelberg, Heidelberg, Germany

    S Dietrich & P Dreger

  2. Genome Biology Unit, European Molecular Biology Laboratory, University of Heidelberg, Heidelberg, Germany

    S Dietrich

  3. Department of Haematology, Lymphoma Working Party, European Society for Blood and Marrow Transplantation, Paris, France

    S Dietrich, H Finel, S Montoto, S Robinson, A Boumendil, A Sureda & P Dreger

  4. Department of Haematology, Hospital Clinic, Barcelona, Spain

    C Martinez

  5. Department of Haematology, Klinikum Grosshadern, Munich, Germany

    J Tischer

  6. Department of Haematology, Institut Paoli Calmettes, Marseille, France

    D Blaise

  7. Department of Haematology, CHU, Nantes, France

    P Chevallier

  8. Department of Haematology, Istituto Clinico Humanitas, Milano, Italy

    L Castagna

  9. Department of Haematology, Hôpital Haut-leveque, Bordeaux, France

    N Milpied

  10. Department of Haematology, Ospedale San Martino, Genova, Italy

    A Bacigalupo

  11. Department of Haematology, Istituto Nazionale dei Tumori, Milano, Italy

    P Corradini

  12. Department of Haematology, Hopital Saint Antoine, Paris, France

    M Mohty

  13. Department of Haematology, Hospital Universitario La Fe, Valencia, Spain

    M Sanz

  14. Department of Haematology, KlinikumSchwabing, Munich, Germany

    A Hausmann

  15. Department of Haematology, St, Bartholomew's and The Royal London NHS Trust, London, UK

    S Montoto

  16. Department of Haematology, University Hospital Bristol NHS Foundation Trust, Bristol, UK

    S Robinson

  17. Department of Haematology, Institut Català d'Oncologia, Hospital Duran i Reynals, Barcelona, Spain

    A Sureda

Authors
  1. S Dietrich
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  2. H Finel
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  3. C Martinez
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  4. J Tischer
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  5. D Blaise
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  7. L Castagna
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  8. N Milpied
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  9. A Bacigalupo
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  10. P Corradini
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  11. M Mohty
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  12. M Sanz
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  13. A Hausmann
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  14. S Montoto
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  15. S Robinson
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  16. A Boumendil
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  17. A Sureda
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  18. P Dreger
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on behalf of the EBMT Lymphoma Working Party

Corresponding author

Correspondence to S Dietrich.

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The authors declare no conflict of interest.

Additional information

Presented in part in abstract form at the 56th Annual Meeting of the American Society of Hematology, San Francisco, USA, December 2014; and at the 41th Annual Meeting of the European Society of Blood and Marrow Transplantation, Istanbul, Turkey, April 2015.

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Dietrich, S., Finel, H., Martinez, C. et al. Post-transplant cyclophosphamide-based haplo-identical transplantation as alternative to matched sibling or unrelated donor transplantation for non-Hodgkin lymphoma: a registry study by the European society for blood and marrow transplantation. Leukemia 30, 2086–2089 (2016). https://doi.org/10.1038/leu.2016.125

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