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Impact of type of reduced-intensity conditioning regimen on the outcomes of allogeneic haematopoietic cell transplantation in classical Hodgkin lymphoma.
Br J Haematol. 2020 Apr 21 [Online ahead of print]BJ

Abstract

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).

Authors+Show Affiliations

MD Anderson Cancer Center, University of Texas, Houston, TX, USA.Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA.Department of Medicine, CIBMTR® (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI, USA. Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA.Department of Medicine, CIBMTR® (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI, USA.Department of Medicine, CIBMTR® (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI, USA.Hematology Department, Institut Catalá d'Oncologia - Hospitalet, Barcelona, Spain. IDIBELL-Institut Català d'Oncologia, l'Hospitalet de Llobregat, El Prat de Llobregat, Spain.Department of Medicine, CIBMTR® (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI, USA. Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Department of Pediatrics, New York Medical College, Valhalla, NY, USA.City of Hope, Duarte, CA, USA.Division of Hematology, The Ohio State University, Columbus, OH, USA.Rush University Medical Center, Chicago, IL, USA.Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA.Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden. Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden.Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.Maastricht University Medical Centre, Maastricht, the Netherlands.Division of Hematology and Oncology, Mount Sinai Hospital, New York, NY, USA.National Cancer Institute- NIH, Bethesda, MD, USA.Divsion of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA, USA.Division of Hematology, Oncology and Blood & Marrow Transplantation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.Department of Hematology and Oncology, Dokkyo Medical University, Tochigi, Japan.Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA.Hematology Department, Institut Català d'Oncologia - Hospitalet, IDIBELL, University of Barcelona, Barcelona, Spain.Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.Department of Medicine, CIBMTR® (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI, USA. Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32314807

Citation

Ahmed, Sairah, et al. "Impact of Type of Reduced-intensity Conditioning Regimen On the Outcomes of Allogeneic Haematopoietic Cell Transplantation in Classical Hodgkin Lymphoma." British Journal of Haematology, 2020.
Ahmed S, Ghosh N, Ahn KW, et al. Impact of type of reduced-intensity conditioning regimen on the outcomes of allogeneic haematopoietic cell transplantation in classical Hodgkin lymphoma. Br J Haematol. 2020.
Ahmed, S., Ghosh, N., Ahn, K. W., Khanal, M., Litovich, C., Mussetti, A., Chhabra, S., Cairo, M., Mei, M., William, B., Nathan, S., Bejanyan, N., Olsson, R. F., Dahi, P. B., van der Poel, M., Steinberg, A., Kanakry, J., Cerny, J., Farooq, U., ... Hamadani, M. (2020). Impact of type of reduced-intensity conditioning regimen on the outcomes of allogeneic haematopoietic cell transplantation in classical Hodgkin lymphoma. British Journal of Haematology. https://doi.org/10.1111/bjh.16664
Ahmed S, et al. Impact of Type of Reduced-intensity Conditioning Regimen On the Outcomes of Allogeneic Haematopoietic Cell Transplantation in Classical Hodgkin Lymphoma. Br J Haematol. 2020 Apr 21; PubMed PMID: 32314807.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of type of reduced-intensity conditioning regimen on the outcomes of allogeneic haematopoietic cell transplantation in classical Hodgkin lymphoma. AU - Ahmed,Sairah, AU - Ghosh,Nilanjan, AU - Ahn,Kwang W, AU - Khanal,Manoj, AU - Litovich,Carlos, AU - Mussetti,Alberto, AU - Chhabra,Saurabh, AU - Cairo,Mitchell, AU - Mei,Matthew, AU - William,Basem, AU - Nathan,Sunita, AU - Bejanyan,Nelli, AU - Olsson,Richard F, AU - Dahi,Parastoo B, AU - van der Poel,Marjolein, AU - Steinberg,Amir, AU - Kanakry,Jennifer, AU - Cerny,Jan, AU - Farooq,Umar, AU - Seo,Sachiko, AU - Kharfan-Dabaja,Mohamed A, AU - Sureda,Anna, AU - Fenske,Timothy S, AU - Hamadani,Mehdi, Y1 - 2020/04/21/ PY - 2020/01/17/received PY - 2020/03/17/revised PY - 2020/03/22/accepted PY - 2020/4/22/entrez KW - allogeneic hematopoietic cell transplant KW - classical Hodgkin lymphoma KW - reduced-intensity conditioning JF - British journal of haematology JO - Br. J. Haematol. N2 - 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). SN - 1365-2141 UR - https://www.unboundmedicine.com/medline/citation/32314807/Impact_of_type_of_reduced_intensity_conditioning_regimen_on_the_outcomes_of_allogeneic_haematopoietic_cell_transplantation_in_classical_Hodgkin_lymphoma_ L2 - https://doi.org/10.1111/bjh.16664 DB - PRIME DP - Unbound Medicine ER -
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