Haploidentical versus matched related donor in Hodgkin’s lymphoma

Jordan Gauthier of CHRU Lille in Lille, France, and colleagues published findings of a retrospective review of transplant outcomes in Hodgkin’s lymphoma patients from either a haploidentical or matched related donor. The findings were published in the online version of Biology of Blood and Marrow Transplantation in January 2018. 

This multicenter review had a primary objective to compare rates of graft-versus-host disease-free relapse-free survival (GRFS) in Hodgkin’s lymphoma patients with advanced disease.  Graft-versus-host disease-free was defined as the absence of grade 3 or 4 GvHD. 

Patient population

• N = 151 patients
  • Haploidentical (Haplo) donor = 61 patients
  • Matched related donor (MRD) = 90 patients
• Haplo donor relationships
  • Sibling = 49%
  • Parent = 34%
  • Offspring = 6%
  • Unknown = 10%
• Conditioning regimen
  • Non-myeloablative (NMA): Haplo = 93%
  • Reduced intensity (RIC): MRD = 94%
  • Total body irradiation (TBI): Haplo = 92% vs MRD = 8%
• Bone marrow stem cell source: Haplo = 51% vs MRD = 14%

Key Findings

• Platelet recovery at 30 days: Haplo = 71% vs MRD = 61%, P = 0.001
• No differences in neutrophils at 30 days, time to neutrophil recovery or chimerism at day +100
  • Neutrophil recovery day +30: Haplo = 98% vs MRD = 99%, P = 0.17
  • Time to neutrophil recovery: Haplo = 19 days vs MRD = 18 days
  • Full chimerism at day +100: Haplo = 64% vs MRD = 61%
• Two-year GRFS univariate analysis
  • Haplo = 58% vs MRD = 42%, P = 0.03
  • NMA = 58% vs RIC = 41%, P = 0.03
  • No difference in GRFS based on disease status, PET scan positivity, stem cell source or age at transplant
• Two-year cumulative incidence of relapse univariate analysis
  • Complete response (CR) = 10% vs non-CR = 28%, P = 0.004
  • PET positive at transplant = 24% vs PET negative at transplant = 11%, P = 0.03
  • Age ≤ 28 years = 24% vs age ≥ 28 years = 11%, P = 0.04
  • No difference in incidence of relapse based on donor type, stem cell source or conditioning regimen
  • Two-year overall survival was not influence by any of the observed variables
  • Two-year non-relapse mortality was not influence by any of the observed variables
• Multivariate analysis for GRFS
  • MRD lower GFRS vs haplo (HR = 2.95, 95% CI 1.72-5.1)
  • Non-CR status lower GRFS vs CR (HR = 1.74, 95% CI 1.12-2.68) P = 0.01
  • Anti-thymocyte globulin (ATG) increased GRFS vs no ATG (HR = 0.52, 95% CI 0.32-0.85), P = 0.001

Data from this retrospective chart review suggests that haploidentical donors may lead to improved GRFS in Hodgkin’s lymphoma.  However, the donor selection did not influence overall survival or 2-year incidence of disease relapse. The haploidentical patients all received cyclophosphamide after transplant and ultimately had a lower incidence of chronic GvHD. This represents a promising treatment option for patients with advanced Hodgkin’s lymphoma.