GRAFT SOURCE AND PRE-TRANSPLANT DISEASE STATUS ARE THE MAIN VARIABLES AFFECTING THE OUTCOME OF T CELL-REPLETE HAPLOIDENTICAL TRANSPLANTATION WITH POST-TRANSPLANT CYCLOPHOSPHAMIDE FOR HODGKIN LYMPHOMA
Author(s): ,
Jacopo Mariotti
Affiliations:
Istituto Clinico Humanitas,Rozzano,Italy
,
Raynier Devillier
Affiliations:
Institut Paoli Calmettes,Marseille,France
,
Stefania Bramanti
Affiliations:
Hematology,Istituto Clinico Humanitas,Rozzano,Italy
,
Laura Giordano
Affiliations:
Division of Biostatistics,Istituto Clinico Humanitas,Rozzano,Italy
,
Barbara Sarina
Affiliations:
Hematology,Istituto Clinico Humanitas,Rozzano,Italy
,
Sabine Furst
Affiliations:
Hematology,Institut Paoli Calmettes,Marseille,France
,
Angela Granata
Affiliations:
Hematology,Institut Paoli Calmettes,Marseille,France
,
Valerio Maisano
Affiliations:
Hematology,Institut Paoli Calmettes,Marseille,France
,
Thomas Pagliardini
Affiliations:
Hematology,Institut Paoli Calmettes,marseille,France
,
Chiara De Philippis
Affiliations:
Hematology,Istituto CLinico Humanitas,Rozzano,Italy
,
Maria Kogan
Affiliations:
Hematology,Istituto Clinico Humanitas,Rozzano,Italy
,
Catherine Faucher
Affiliations:
Hematology,Institut Paoli Calmettes,Marseille,France
,
Samia Harbi
Affiliations:
Hematology,Institut Paoli Calmettes,Marseille,France
,
Christian Chabannon
Affiliations:
Cell Therapy Unit,Institut Paoli Calmettes,Marseille,France
,
Carmelo Carlo-Stella
Affiliations:
Hematology,Istituto Clinico Humanitas,Rozzano,Italy
,
Reda Bouabdallah
Affiliations:
Hematology,Institut Paoli Calmettes,Marseille,France
,
Armando Santoro
Affiliations:
Hematology,Istituto Clinico Humanitas,Rozzano,Italy
,
Didier Blaise
Affiliations:
Hematology,Institut Paoli Calmettes,Marseille,France
Luca Castagna
Affiliations:
Hematology,Istituto Clinico Humanitas,Rozzano,Italy
EHA Library. Mariotti J. Jun 15, 2019; 266863; PS1246
Jacopo Mariotti
Jacopo Mariotti
Contributions
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Abstract

Abstract: PS1246

Type: Poster Presentation

Presentation during EHA24: On Saturday, June 15, 2019 from 17:30 - 19:00

Location: Poster area

Background
Haploidentical stem cell transplantation (Haplo-SCT) with post-transplant cyclophosphamide (PT-Cy) represents a potential curative strategy for patients with Hodgkin lymphoma (HL) when a matched related or unrelated donor is not available1. While bone marrow (BM) was originally the preferred stem cell source, more recently peripheral blood stem cell (PBSC) is more often used. Some retrospective studies suggest that the risk to develop acute and chronic graft-versus-host-disease (GVHD) is higher with PBSC than BM, while PBSC may reduce the risk of relapse2

Aims
Here we analyzed the effect of stem cell source in 91 HL patients receiving Haplo-SCT with PT-Cy, with the aim to evaluate if the final outcome is modified by the use of PBSC or BM

Methods
From April 2009 to January 2017, 91 consecutive patients with poor prognosis HL received a Haplo-SCT with PT-Cy either from a PBSC (n=38) or BM (n=53). The two cohorts were similar for most characteristics, but the PBSC group had more patients with an unfavorable hematopoietic stem cell transplant comorbidity index (HCT-CI) score ≥3 (p=0.002) and had received a non myeloablative conditioning (NMAC; p=0.001).

Results

Cumulative incidence of neutrophil>500/ul at day +30 and of platelet >20000/ul at day +60 were 96% (95% CI: 89-98) and 96% (95% CI: 88-99), respectively, with no significant differences between the PBSC and BM cohorts. With a median follow-up of 22.8 months, there was no difference between PBSC and BM graft in terms of cumulative incidence of grade 2-4 acute GVHD (29% vs 21%, p=0.3), grade 3-4 acute GVHD (3% vs 4%, p=0.7) and moderate-severe chronic GVHD (9% vs 7%, p=0.7). This was also confirmed by multivariate analysis (data not shown). In the whole population, the 2-year overall survival (OS), 2-year progression-free survival (PFS) and 1-year GVHD/relapse free survival (GRFS) rates were 67%, 58% and 58%, respectively. We observed a trend for improved OS (74% vs 62%, p= 0.07) and PFS (62% vs 56%, p= 0.1) for recipients of PBSC relative to BM cells, but pre-transplant disease status was the only significant variable by univariate analysis (Table I). By multivariate analysis, PBSC resulted a protective factor both for OS (HR: 0.29, p=0.006), PFS (HR: 0.38, p=0.001) and GRFS (HR: 0.44, p=0.020). The other independent variables affecting the final outcome were pre-transplant disease status and hematopoietic cell transplant comorbidity index (HCT-CI) (Table I). Non-relapse mortality was not affected by graft source both by univariate and multivariate analysis, while pre-transplant disease status was the only variable affecting the chance of disease relapse.

Conclusion
Overall these data suggest that PBSC is associated with better outcome, in terms of OS, PFS and GRFS, relative to BM cells as graft source for patients undergoing Haplo-SCT with PT-Cy. In addition, the risk of acute and chronic GVHD is not increased after PBSC relative to BM graft.

Session topic: 17. Hodgkin lymphoma - Clinical

Keyword(s): Peripheral blood stem cell transplant, Transplant

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