Contributions
Abstract: S128
Type: Oral Presentation
Presentation during EHA23: On Friday, June 15, 2018 from 12:30 - 12:45
Location: Room A6
Background
Allogeneic hematopoietic cell transplantation (alloHCT) from haplo-identical donors using immunosuppression with post-transplant cyclophosphamide (ptCY) is increasingly performed in patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL). Disease-specific outcome data for ptCY-based haplo-transplantation (haploHCT) have not been reported for DLBCL to date.
Aims
To compare the outcomes of haploHCT with that of fully matched sibling transplants (msdHCT) as standard reference donor source in patients with DLBCL.
Methods
Eligible for this retrospective registry study were patients aged 18 or older who had undergone a reduced-intensity conditioning (RIC) haploHCT or msdHCT for DLBCL between January 2008 and June 2015 and were registered with the CIBMTR or the EBMT. Primary endpoint was overall survival (OS); secondary endpoints included engraftment, acute and chronic GVHD, non-relapse mortality (NRM), relapse/progression incidence (REL) and progression-free survival (PFS).
Results
Altogether 657 patients were eligible (haploHCT 132; msdHCT 525). HaploHCT and msdHCT recipients were comparable for gender, comorbidity score, time from diagnosis, and disease status at alloHCT. However, haploHCT patients were significantly older (58 vs 55 years), more likely to have a Karnofsky score of 90-100 (73% vs 62%), had less often received a prior autoHCT (42% vs 55%), and had been allotransplanted more recently. Moreover, haploHCT and msdHCT recipients differed fundamentally in terms of use of TBI-based conditioning (86% vs 21%) and graft source bone marrow (76% vs 2%).
On univariate and multivariate comparisons, OS, PFS, REL, and NRM were not significantly different between haploHCT and msdHCT with 3-year estimates of 46% vs 50%, 38% vs 37%, 41% v 47%, and 22% v 17%, respectively. Engraftment was significantly delayed after haploHCT vs msdHCT (neutrophils >0.5/nl at d +28 90% vs 97%, p=0.01; platelets >20/nl at d +28 61% vs 92%, p<0.001). Whilst the cumulative incidence of d +180 grade 3-4 acute GVHD was comparable (haploHCT vs msdHCT 7% vs 11%, p=0.07), there was a significantly lower 1-year incidence of chronic GVHD after haploHCT vs msdHCT (15% vs 41%; p<0.001; relative risk (RR) 0.31 (95%CI 0.27-0.47) after multivariate adjustment for confounders). Factors significantly impairing OS, PFS, REL (but not NRM) on multivariate analysis were lower Karnofsky performance status and advanced disease status at alloHCT.
Conclusion
This data suggests that in DLBCL survival, REL and NRM after RIC haploHCT is comparable to that after RIC msdHCT despite a lower risk of chronic GVHD. Although delayed engraftment has to be taken into account, RIC haploHCT might be a reasonable substitute for RIC msdHCT in the absence of a matched related donor.
Session topic: 23. Stem cell transplantation - Clinical
Keyword(s): Diffuse large B cell lymphoma, Transplant
Abstract: S128
Type: Oral Presentation
Presentation during EHA23: On Friday, June 15, 2018 from 12:30 - 12:45
Location: Room A6
Background
Allogeneic hematopoietic cell transplantation (alloHCT) from haplo-identical donors using immunosuppression with post-transplant cyclophosphamide (ptCY) is increasingly performed in patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL). Disease-specific outcome data for ptCY-based haplo-transplantation (haploHCT) have not been reported for DLBCL to date.
Aims
To compare the outcomes of haploHCT with that of fully matched sibling transplants (msdHCT) as standard reference donor source in patients with DLBCL.
Methods
Eligible for this retrospective registry study were patients aged 18 or older who had undergone a reduced-intensity conditioning (RIC) haploHCT or msdHCT for DLBCL between January 2008 and June 2015 and were registered with the CIBMTR or the EBMT. Primary endpoint was overall survival (OS); secondary endpoints included engraftment, acute and chronic GVHD, non-relapse mortality (NRM), relapse/progression incidence (REL) and progression-free survival (PFS).
Results
Altogether 657 patients were eligible (haploHCT 132; msdHCT 525). HaploHCT and msdHCT recipients were comparable for gender, comorbidity score, time from diagnosis, and disease status at alloHCT. However, haploHCT patients were significantly older (58 vs 55 years), more likely to have a Karnofsky score of 90-100 (73% vs 62%), had less often received a prior autoHCT (42% vs 55%), and had been allotransplanted more recently. Moreover, haploHCT and msdHCT recipients differed fundamentally in terms of use of TBI-based conditioning (86% vs 21%) and graft source bone marrow (76% vs 2%).
On univariate and multivariate comparisons, OS, PFS, REL, and NRM were not significantly different between haploHCT and msdHCT with 3-year estimates of 46% vs 50%, 38% vs 37%, 41% v 47%, and 22% v 17%, respectively. Engraftment was significantly delayed after haploHCT vs msdHCT (neutrophils >0.5/nl at d +28 90% vs 97%, p=0.01; platelets >20/nl at d +28 61% vs 92%, p<0.001). Whilst the cumulative incidence of d +180 grade 3-4 acute GVHD was comparable (haploHCT vs msdHCT 7% vs 11%, p=0.07), there was a significantly lower 1-year incidence of chronic GVHD after haploHCT vs msdHCT (15% vs 41%; p<0.001; relative risk (RR) 0.31 (95%CI 0.27-0.47) after multivariate adjustment for confounders). Factors significantly impairing OS, PFS, REL (but not NRM) on multivariate analysis were lower Karnofsky performance status and advanced disease status at alloHCT.
Conclusion
This data suggests that in DLBCL survival, REL and NRM after RIC haploHCT is comparable to that after RIC msdHCT despite a lower risk of chronic GVHD. Although delayed engraftment has to be taken into account, RIC haploHCT might be a reasonable substitute for RIC msdHCT in the absence of a matched related donor.
Session topic: 23. Stem cell transplantation - Clinical
Keyword(s): Diffuse large B cell lymphoma, Transplant