Impact of type of reduced-intensity conditioning regimen on the outcomes of allogeneic haematopoietic cell transplantation in classical Hodgkin lymphoma. Br J Haematol 2020 Aug;190(4):573-582
Date
04/22/2020Pubmed ID
32314807Pubmed Central ID
PMC7575614DOI
10.1111/bjh.16664Scopus ID
2-s2.0-85083643436 (requires institutional sign-in at Scopus site) 16 CitationsAbstract
Reduced-intensity conditioning (RIC) allogeneic haematopoietic cell transplantation (allo-HCT) is a curative option for select relapsed/refractory Hodgkin lymphoma (HL) patients; however, there are sparse data to support superiority of any particular conditioning regimen. We analyzed 492 adult patients undergoing human leucocyte antigen (HLA)-matched sibling or unrelated donor allo-HCT for HL between 2008 and 2016, utilizing RIC with either fludarabine/busulfan (Flu/Bu), fludarabine/melphalan (Flu/Mel140) or fludarabine/cyclophosphamide (Flu/Cy). Multivariable regression analysis was performed using a significance level of <0·01. There were no significant differences between regimens in risk for non-relapse mortality (NRM) (P = 0·54), relapse/progression (P = 0·02) or progression-free survival (PFS) (P = 0·14). Flu/Cy conditioning was associated with decreased risk of mortality in the first 11 months after allo-HCT (HR = 0·28; 95% CI = 0·10-0·73; P = 0·009), but beyond 11 months post allo-HCT it was associated with a significantly higher risk of mortality, (HR = 2·46; 95% CI = 0·1.32-4·61; P = 0·005). Four-year adjusted overall survival (OS) was similar across regimens at 62% for Flu/Bu, 59% for Flu/Mel140 and 55% for Flu/Cy (P = 0·64), respectively. These data confirm the choice of RIC for allo-HCT in HL does not influence risk of relapse, NRM or PFS. Although no OS benefit was seen between Flu/Bu and Flu/Mel 140; Flu/Cy was associated with a significantly higher risk of mortality beyond 11 months from allo-HCT (possibly due to late NRM events).
Author List
Ahmed S, Ghosh N, Ahn KW, Khanal M, Litovich C, Mussetti A, Chhabra S, Cairo M, Mei M, William B, Nathan S, Bejanyan N, Olsson RF, Dahi PB, van der Poel M, Steinberg A, Kanakry J, Cerny J, Farooq U, Seo S, Kharfan-Dabaja MA, Sureda A, Fenske TS, Hamadani MAuthors
Kwang Woo Ahn PhD Professor in the Institute for Health and Equity department at Medical College of WisconsinTimothy Fenske MD Professor in the Medicine department at Medical College of Wisconsin
Mehdi H. Hamadani MD Professor in the Medicine department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdolescentAdult
Aged
Allografts
Busulfan
Cause of Death
Comorbidity
Cyclophosphamide
Female
Graft vs Host Disease
Hematopoietic Stem Cell Transplantation
Hodgkin Disease
Humans
Kaplan-Meier Estimate
Male
Melphalan
Middle Aged
Myeloablative Agonists
Recurrence
Siblings
Transplantation Conditioning
Unrelated Donors
Vidarabine
Young Adult