Journal
BRITISH JOURNAL OF HAEMATOLOGY
Volume 190, Issue 4, Pages 573-582Publisher
WILEY
DOI: 10.1111/bjh.16664
Keywords
reduced-intensity conditioning; allogeneic hematopoietic cell transplant; classical Hodgkin lymphoma
Categories
Funding
- Public Health Service Grant from the National Cancer Institute (NCI) [5U24CA076518]
- National Heart, Lung and Blood Institute (NHLBI) [5U24CA076518]
- National Institute of Allergy and Infectious Diseases (NIAID) [5U24CA076518]
- NHLBI [4U10HL069294]
- NCI [4U10HL069294]
- Health Resources and Services Administration (HRSA/DHHS) [HHSH250201200016C]
- Office of Naval Research [N00014-17-1-2388, N00014-16-1-2020]
- Actinium Pharmaceuticals, Inc.
- Amgen, Inc.
- Amneal Biosciences
- Angiocrine Bioscience, Inc.
- Astellas Pharma US
- Atara Biotherapeutics, Inc.
- Be the Match Foundation
- bluebird bio, Inc.
- Bristol Myers Squibb Oncology
- Celgene Corporation
- Cerus Corporation
- Chimerix, Inc.
- Fred Hutchinson Cancer Research Center
- Gamida Cell Ltd.
- Gilead Sciences, Inc.
- HistoGenetics, Inc.
- Immucor
- Janssen Scientific Affairs, LLC
- Jazz Pharmaceuticals, Inc.
- Juno Therapeutics
- Karyopharm Therapeutics, Inc.
- Kite Pharma, Inc.
- Medac, GmbH
- MedImmune
- Medical College of Wisconsin
- Merck Co, Inc.
- Mesoblast
- MesoScale Diagnostics, Inc.
- Millennium, the Takeda Oncology Co.
- Miltenyi Biotec, Inc.
- National Marrow Donor Program
- Neovii Biotech NA, Inc.
- Novartis Pharmaceuticals Corporation
- Otsuka Pharmaceutical Co, Ltd. - Japan
- PCORI
- Pfizer, Inc
- Pharmacyclics, LLC
- PIRCHE AG
- Sanofi Genzyme
- Seattle Genetics
- Shire
- Spectrum Pharmaceuticals, Inc.
- St. Baldrick's Foundation
- Sunesis Pharmaceuticals, Inc.
- Swedish Orphan Biovitrum, Inc.
- Takeda Oncology
- Telomere Diagnostics, Inc.
- University of Minnesota
- Incyte Corporation
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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 center dot 01. There were no significant differences between regimens in risk for non-relapse mortality (NRM) (P = 0 center dot 54), relapse/progression (P = 0 center dot 02) or progression-free survival (PFS) (P = 0 center dot 14). Flu/Cy conditioning was associated with decreased risk of mortality in the first 11 months after allo-HCT (HR = 0 center dot 28; 95% CI = 0 center dot 10-0 center dot 73; P = 0 center dot 009), but beyond 11 months post allo-HCT it was associated with a significantly higher risk of mortality, (HR = 2 center dot 46; 95% CI = 0 center dot 1.32-4 center dot 61; P = 0 center dot 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 center dot 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).
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