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Combined Haploidentical and Umbilical Cord Blood Allogeneic Stem Cell Transplantation for High-Risk Lymphoma and Chronic Lymphoblastic Leukemia.
Biol Blood Marrow Transplant. 2018 02; 24(2):359-365.BB

Abstract

Limited studies have reported on outcomes for lymphoid malignancy patients receiving alternative donor allogeneic stem cell transplants. We have previously described combining CD34-selected haploidentical grafts with umbilical cord blood (haplo-cord) to accelerate neutrophil and platelet engraftment. Here, we examine the outcome of patients with lymphoid malignancies undergoing haplo-cord transplantation at the University of Chicago and Weill Cornell Medical College. We analyzed 42 lymphoma and chronic lymphoblastic leukemia (CLL) patients who underwent haplo-cord allogeneic stem cell transplantation. Patients underwent transplant for Hodgkin lymphoma (n = 9, 21%), CLL (n = 5, 12%) and non-Hodgkin lymphomas (n = 28, 67%), including 13 T cell lymphomas. Twenty-four patients (52%) had 3 or more lines of therapies. Six (14%) and 1 (2%) patients had prior autologous and allogeneic stem cell transplant, respectively. At the time of transplant 12 patients (29%) were in complete remission, 18 had chemotherapy-sensitive disease, and 12 patients had chemotherapy-resistant disease. Seven (17%), 11 (26%), and 24 (57%) patients had low, intermediate, and high disease risk index before transplant. Comorbidity index was evenly distributed among 3 groups, with 13 (31%), 14 (33%), and 15 (36%) patients scoring 0, 1 to 2, and ≥3. Median age for the cohort was 49 years (range, 23 to 71). All patients received fludarabine/melphalan/antithymocyte globulin conditioning regimen and post-transplant graft-versus-host disease (GVHD) prophylaxis with tacrolimus and mycophenolate mofetil. The median time to neutrophil engraftment was 11 days (range, 9 to 60) and to platelet engraftment 19.5 days (range, 11 to 88). Cumulative incidence of nonrelapse mortality was 11.6% at 100 days and 19 % at one year. Cumulative incidence of relapse was 9.3% at 100 days and 19% at one year. With a median follow-up of survivors of 42 months, the 3-year rates of GVHD relapse free survival, progression-free survival, and overall survival were 53%, 62%, and 65%, respectively, for these patients. Only 8% of the survivors had chronic GVHD. In conclusion, haplo-cord transplantation offers a transplant alternative for patients with recurrent or refractory lymphoid malignancies who lack matching donors. Both neutrophil and platelet count recovery is rapid, nonrelapse mortality is limited, excellent disease control can be achieved, and the incidence of chronic GVHD is limited. Thus, haplo-cord achieves high rates of engraftment and encouraging results.

Authors+Show Affiliations

Department of Hematology/Oncology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York.Section of Hematology/Oncology, University of Chicago, Chicago, Illinois.Department of Hematology/Oncology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York.Department of Hematology/Oncology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York.Section of Hematology/Oncology, University of Chicago, Chicago, Illinois.Department of Pathology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York.Section of Hematology/Oncology, University of Chicago, Chicago, Illinois.Department of Hematology/Oncology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York.Section of Hematology/Oncology, University of Chicago, Chicago, Illinois.Department of Hematology/Oncology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York.Department of Hematology/Oncology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York.Department of Hematology/Oncology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York.Section of Hematology/Oncology, University of Chicago, Chicago, Illinois.Section of Hematology/Oncology, University of Chicago, Chicago, Illinois.Department of Pathology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York.Department of Hematology/Oncology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York.Department of Hematology/Oncology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York. Electronic address: kov9001@med.cornell.edu.

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29128555

Citation

Hsu, Jingmei, et al. "Combined Haploidentical and Umbilical Cord Blood Allogeneic Stem Cell Transplantation for High-Risk Lymphoma and Chronic Lymphoblastic Leukemia." Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation, vol. 24, no. 2, 2018, pp. 359-365.
Hsu J, Artz A, Mayer SA, et al. Combined Haploidentical and Umbilical Cord Blood Allogeneic Stem Cell Transplantation for High-Risk Lymphoma and Chronic Lymphoblastic Leukemia. Biol Blood Marrow Transplant. 2018;24(2):359-365.
Hsu, J., Artz, A., Mayer, S. A., Guarner, D., Bishop, M. R., Reich-Slotky, R., Smith, S. M., Greenberg, J., Kline, J., Ferrante, R., Phillips, A. A., Gergis, U., Liu, H., Stock, W., Cushing, M., Shore, T. B., & van Besien, K. (2018). Combined Haploidentical and Umbilical Cord Blood Allogeneic Stem Cell Transplantation for High-Risk Lymphoma and Chronic Lymphoblastic Leukemia. Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation, 24(2), 359-365. https://doi.org/10.1016/j.bbmt.2017.10.040
Hsu J, et al. Combined Haploidentical and Umbilical Cord Blood Allogeneic Stem Cell Transplantation for High-Risk Lymphoma and Chronic Lymphoblastic Leukemia. Biol Blood Marrow Transplant. 2018;24(2):359-365. PubMed PMID: 29128555.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Combined Haploidentical and Umbilical Cord Blood Allogeneic Stem Cell Transplantation for High-Risk Lymphoma and Chronic Lymphoblastic Leukemia. AU - Hsu,Jingmei, AU - Artz,Andrew, AU - Mayer,Sebastian A, AU - Guarner,Danielle, AU - Bishop,Michael R, AU - Reich-Slotky,Ronit, AU - Smith,Sonali M, AU - Greenberg,June, AU - Kline,Justin, AU - Ferrante,Rosanna, AU - Phillips,Adrienne A, AU - Gergis,Usama, AU - Liu,Hongtao, AU - Stock,Wendy, AU - Cushing,Melissa, AU - Shore,Tsiporah B, AU - van Besien,Koen, Y1 - 2017/11/08/ PY - 2017/07/31/received PY - 2017/10/28/accepted PY - 2017/11/13/pubmed PY - 2019/3/26/medline PY - 2017/11/13/entrez KW - Allogeneic stem cell transplant KW - Alternative donor transplant KW - Combined haploidentical and umbilical cord blood donor graft KW - High-risk lymphoma SP - 359 EP - 365 JF - Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation JO - Biol. Blood Marrow Transplant. VL - 24 IS - 2 N2 - Limited studies have reported on outcomes for lymphoid malignancy patients receiving alternative donor allogeneic stem cell transplants. We have previously described combining CD34-selected haploidentical grafts with umbilical cord blood (haplo-cord) to accelerate neutrophil and platelet engraftment. Here, we examine the outcome of patients with lymphoid malignancies undergoing haplo-cord transplantation at the University of Chicago and Weill Cornell Medical College. We analyzed 42 lymphoma and chronic lymphoblastic leukemia (CLL) patients who underwent haplo-cord allogeneic stem cell transplantation. Patients underwent transplant for Hodgkin lymphoma (n = 9, 21%), CLL (n = 5, 12%) and non-Hodgkin lymphomas (n = 28, 67%), including 13 T cell lymphomas. Twenty-four patients (52%) had 3 or more lines of therapies. Six (14%) and 1 (2%) patients had prior autologous and allogeneic stem cell transplant, respectively. At the time of transplant 12 patients (29%) were in complete remission, 18 had chemotherapy-sensitive disease, and 12 patients had chemotherapy-resistant disease. Seven (17%), 11 (26%), and 24 (57%) patients had low, intermediate, and high disease risk index before transplant. Comorbidity index was evenly distributed among 3 groups, with 13 (31%), 14 (33%), and 15 (36%) patients scoring 0, 1 to 2, and ≥3. Median age for the cohort was 49 years (range, 23 to 71). All patients received fludarabine/melphalan/antithymocyte globulin conditioning regimen and post-transplant graft-versus-host disease (GVHD) prophylaxis with tacrolimus and mycophenolate mofetil. The median time to neutrophil engraftment was 11 days (range, 9 to 60) and to platelet engraftment 19.5 days (range, 11 to 88). Cumulative incidence of nonrelapse mortality was 11.6% at 100 days and 19 % at one year. Cumulative incidence of relapse was 9.3% at 100 days and 19% at one year. With a median follow-up of survivors of 42 months, the 3-year rates of GVHD relapse free survival, progression-free survival, and overall survival were 53%, 62%, and 65%, respectively, for these patients. Only 8% of the survivors had chronic GVHD. In conclusion, haplo-cord transplantation offers a transplant alternative for patients with recurrent or refractory lymphoid malignancies who lack matching donors. Both neutrophil and platelet count recovery is rapid, nonrelapse mortality is limited, excellent disease control can be achieved, and the incidence of chronic GVHD is limited. Thus, haplo-cord achieves high rates of engraftment and encouraging results. SN - 1523-6536 UR - https://www.unboundmedicine.com/medline/citation/29128555/Combined_Haploidentical_and_Umbilical_Cord_Blood_Allogeneic_Stem_Cell_Transplantation_for_High_Risk_Lymphoma_and_Chronic_Lymphoblastic_Leukemia_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1083-8791(17)30809-1 DB - PRIME DP - Unbound Medicine ER -