TY - JOUR
T1 - Outcomes of Haploidentical Stem Cell Transplantation for Lymphoma with Melphalan-Based Conditioning
AU - Brammer, Jonathan E.
AU - Khouri, Issa
AU - Gaballa, Sameh
AU - Anderlini, Paolo
AU - Tomuleasa, Ciprian
AU - Ahmed, Sairah
AU - Ledesma, Celina
AU - Hosing, Chitra
AU - Champlin, Richard E.
AU - Ciurea, Stefan O.
N1 - Publisher Copyright:
© 2016 American Society for Blood and Marrow Transplantation
PY - 2016/3/1
Y1 - 2016/3/1
N2 - Haploidentical transplantation (Haplo-SCT) with post-transplantation cyclophosphamide (PTCy) is increasingly utilized for the treatment of lymphoma and almost exclusively with the nonmyeloablative fludarabine (Flu)/cyclophosphamide/total body irradiation (TBI) conditioning regimen. We present early results of a reduced-intensity (RIC) regimen utilizing fludarabine and melphalan (FM) for the treatment of advanced lymphoma. All patients with a diagnosis of lymphoma or chronic lymphocytic leukemia (CLL) who received Haplo-SCT at the University of Texas MD Anderson Cancer Center between 2009 and 2014 were reviewed (N = 22). Patients received Flu 160 mg/m2 and melphalan 100 mg/m2 to 140 mg/m2 with thiotepa 5 mg/kg or 2 Gy TBI. Because of concerns of increased treatment-related mortality (TRM) with the melphalan 140 mg/m2 regimen (FM140), a RIC regimen with melphalan 100 mg/m2 (FM100) was devised. Rituximab was included for CD20+ disease. Graft-versus-host disease prophylaxis consisted of PTCy 50 mg/kg on days +3 and + 4, tacrolimus, and mycophenolate mofetil. Sixty-eight percent of all patients were not in complete remission at the time of transplantation. The 2-year progression-free survival (PFS) and overall survival (OS) for the entire cohort were 54%, 1-year TRM was 19%, and the cumulative incidence of relapse at 2 years was 27%. Two-year PFS for Hodgkin lymphoma, non-Hodgkin lymphoma, and CLL/small lymphocytic lymphoma were 57%, 51%, and 75%. Patients treated with FM100 compared to FM140 had equivalent PFS (71% versus 37%, P =.246) and OS (71% versus 58%, P =.32). These early results establish Flu and melphalan 100 mg/m2 with 2 Gy TBI or thiotepa 5 mg/kg as a very promising conditioning regimen for the treatment of advanced lymphoma with Haplo-SCT and PTCy.
AB - Haploidentical transplantation (Haplo-SCT) with post-transplantation cyclophosphamide (PTCy) is increasingly utilized for the treatment of lymphoma and almost exclusively with the nonmyeloablative fludarabine (Flu)/cyclophosphamide/total body irradiation (TBI) conditioning regimen. We present early results of a reduced-intensity (RIC) regimen utilizing fludarabine and melphalan (FM) for the treatment of advanced lymphoma. All patients with a diagnosis of lymphoma or chronic lymphocytic leukemia (CLL) who received Haplo-SCT at the University of Texas MD Anderson Cancer Center between 2009 and 2014 were reviewed (N = 22). Patients received Flu 160 mg/m2 and melphalan 100 mg/m2 to 140 mg/m2 with thiotepa 5 mg/kg or 2 Gy TBI. Because of concerns of increased treatment-related mortality (TRM) with the melphalan 140 mg/m2 regimen (FM140), a RIC regimen with melphalan 100 mg/m2 (FM100) was devised. Rituximab was included for CD20+ disease. Graft-versus-host disease prophylaxis consisted of PTCy 50 mg/kg on days +3 and + 4, tacrolimus, and mycophenolate mofetil. Sixty-eight percent of all patients were not in complete remission at the time of transplantation. The 2-year progression-free survival (PFS) and overall survival (OS) for the entire cohort were 54%, 1-year TRM was 19%, and the cumulative incidence of relapse at 2 years was 27%. Two-year PFS for Hodgkin lymphoma, non-Hodgkin lymphoma, and CLL/small lymphocytic lymphoma were 57%, 51%, and 75%. Patients treated with FM100 compared to FM140 had equivalent PFS (71% versus 37%, P =.246) and OS (71% versus 58%, P =.32). These early results establish Flu and melphalan 100 mg/m2 with 2 Gy TBI or thiotepa 5 mg/kg as a very promising conditioning regimen for the treatment of advanced lymphoma with Haplo-SCT and PTCy.
KW - Haploidentical stem cell transplantation
KW - Hodgkin's disease
KW - Melphalan conditioning
KW - Non-Hodgkin lymphoma
KW - Post-transplantation cyclophosphamide
UR - http://www.scopus.com/inward/record.url?scp=84951083315&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84951083315&partnerID=8YFLogxK
U2 - 10.1016/j.bbmt.2015.10.015
DO - 10.1016/j.bbmt.2015.10.015
M3 - Article
C2 - 26497906
AN - SCOPUS:84951083315
SN - 1083-8791
VL - 22
SP - 493
EP - 498
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 3
ER -