T Cell-Replete Haploidentical Transplantation with Post-Transplantation Cyclophosphamide for Hodgkin Lymphoma Relapsed after Autologous Transplantation: Reduced Incidence of Relapse and of Chronic Graft-versus-Host Disease Compared with HLA-Identical Related Donors

Jacopo Mariotti , Raynier Devillier (1, 2) , Stefania Bramanti , Barbara Sarina , Sabine Furst (2, 1) , Angela Granata (3) , Catherine Faucher (4, 2, 1) , Samia Harbi (2, 1) , Lucio Morabito , Christian Chabannon (5) , Carmelo Carlo-Stella (6) , Reda Bouabdallah (3) , Armando Santoro , Didier Blaise (7, 5) , Luca Castagna (1, 2, 8)

1 Département d'Hématologie [Marseille]
2 Unité de Transplantation et de Thérapie Cellulaire [Marseille]
3 IPC - Institut Paoli-Calmettes
4 SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD - Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale
5 CRCM - Centre de Recherche en Cancérologie de Marseille
6 UNIMI - Università degli Studi di Milano = University of Milan
7 Service d’Hématologie [Institut Paoli Calmettes, Marseille]
8 Department of Hemato-oncology - Transplant Unit [Milano, Italy]

Allogeneic hematopoietic stem cell transplantation (SCT) represents a potential curative strategy for patients with Hodgkin lymphoma (HL) relapsing after autologous SCT (ASCT), but the incidence of disease relapse is still high. We performed a retrospective study on 64 patients with HL relapsing after ASCT to compare outcomes after HLA-identical SCT (HLAid-SCT; n = 34) and haploidentical SCT with post-transplantation cyclophosphamide (PT-Cy) (Haplo-SCT; n = 30). All patients engrafted, with a significantly shorter median time for neutrophil and platelet engraftment after HLAid compared with Haplo-SCT (14 days versus 19 days and 11 days versus 23 days, respectively; P<.005). With a median follow-up of 47 months, 3-year overall survival (OS), 3-year progression-free survival (PFS), and 1-year nonrelapse mortality (NRM) were 53%, 44% and 17%, respectively. Recipients of Haplo-SCT were less likely to experience disease relapse (3-year cumulative incidence of relapse, 13% versus 62%; P=.0001) and chronic graft-versus-host disease (GVHD; 3% versus 32%; P=.003), resulting in improved PFS (60% versus 29%; P=.04) and GVHD-free/relapse-free survival (47% versus 17%; P=.06). The 3-year OS did not differ between the 2 groups (56% versus 54%; P not significant), and NRM was higher after Haplo-SCT, but the difference did not reach statistical significance (26% versus 9%; P=.09). On multivariate Cox regression analysis, receipt of Haplo-SCT (hazard ratio [HR],.17; P=.02) and achieving optimal disease control (complete remission before SCT: FIR,.6; P<.0001) were the only independent variables associated with a reduced risk of disease relapse. Haplo-SCT is a valid option for patients with HL relapsing after ASCT, with a reduced incidence of relapse compared with HLAid SCT. (C) 2017 American Society for Blood and Marrow Transplantation.

Domaines: Sciences du Vivant [q-bio]

Jacopo Mariotti, Raynier Devillier, Stefania Bramanti, Barbara Sarina, Sabine Furst, et al.. T Cell-Replete Haploidentical Transplantation with Post-Transplantation Cyclophosphamide for Hodgkin Lymphoma Relapsed after Autologous Transplantation: Reduced Incidence of Relapse and of Chronic Graft-versus-Host Disease Compared with HLA-Identical Related Donors. BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION, 2018, 24 (3), pp.627-632. ⟨10.1016/j.bbmt.2017.11.030⟩. ⟨hal-02143565⟩