Alternative donors extend transplantation for patients with lymphoma who lack an HLA matched donor

V. Bachanova; L. J. Burns; T. Wang; J. Carreras; R. P. Gale; P. H. Wiernik; K. K. Ballen; B. Wirk; R. Munker; D. A. Rizzieri; Y. B. Chen; J. Gibson; G. Akpek; L. J. Costa; R. T. Kamble; M. D. Aljurf; J. W. Hsu; M. S. Cairo; H. C. Schouten; U. Bacher; B. N. Savani; J. R. Wingard; H. M. Lazarus; G. G. Laport; S. Montoto; D. G. Maloney; S. M. Smith; C. Brunstein; W. Saber

doi:10.1038/bmt.2014.259

Alternative donors extend transplantation for patients with lymphoma who lack an HLA matched donor

V. Bachanova, L. J. Burns, T. Wang, J. Carreras, R. P. Gale, P. H. Wiernik, K. K. Ballen, B. Wirk, R. Munker, D. A. Rizzieri, Y. B. Chen, J. Gibson, G. Akpek, L. J. Costa, R. T. Kamble, M. D. Aljurf, J. W. Hsu, M. S. Cairo, H. C. Schouten, U. BacherB. N. Savani, J. R. Wingard, H. M. Lazarus, G. G. Laport, S. Montoto, D. G. Maloney, S. M. Smith, C. Brunstein, W. Saber

Research output: Contribution to journal › Article › peer-review

35 Scopus citations

Abstract

Alternative donor transplantation is increasingly used for high-risk lymphoma patients. We analyzed 1593 transplant recipients (2000-2010) and compared transplant outcomes in recipients of 8/8 allele HLA-A, -B, -C and DRB1 matched unrelated donors (MUDs; n=1176), 7/8 allele HLA mismatched unrelated donors (MMUDs; n=275) and umbilical cord blood donors (1 or 2 units UCB; n=142). Adjusted 3-year non-relapse mortality of MMUD (44%) was higher as compared with MUD (35%; P=0.004), but similar to UCB recipients (37%; P=0.19), although UCB had lower rates of neutrophil and platelet recovery compared with unrelated donor groups. With a median follow-up of 55 months, 3-year adjusted cumulative incidence of relapse was lower after MMUD compared with MUD (25% vs 33%, P=0.003) but similar between UCB and MUD (30% vs 33%; P=0.48). In multivariate analysis, UCB recipients had lower risks of acute and chronic GVHD compared with adult donor groups (UCB vs MUD: hazard ratio (HR)=0.68, P=0.05; HR=0.35; P<0.001). Adjusted 3-year OS was comparable (43% MUD, 37% MMUD and 41% UCB). These data highlight the observation that patients with lymphoma have acceptable survival after alternative donor transplantation. MMUD and UCB can extend the curative potential of allotransplant to patients who lack suitable HLA matched sibling or MUD.

Original language	English
Pages (from-to)	197-203
Number of pages	7
Journal	Bone Marrow Transplantation
Volume	50
Issue number	2
DOIs	https://doi.org/10.1038/bmt.2014.259
State	Published - Feb 7 2015

Bibliographical note

Publisher Copyright:
© 2015 Macmillan Publishers Limited All rights reserved.

Funding

The CIBMTR is supported by Public Health Service Grant/Cooperative Agreement U24-CA076518 from the National Cancer Institute (NCI), the National Heart, Lung and Blood Institute (NHLBI) and the National Institute of Allergy and Infectious Diseases (NIAID); a Grant/Cooperative Agreement 5U10HL069294 from NHLBI and NCI; a contract HHSH250201200016C with Health Resources and Services Administration (HRSA/DHHS); two Grants N00014-12-1-0142 and N00014-13-1-0039 from the Office of Naval Research; and grants from *Actinium Pharmaceuticals; Allos Therapeutics Inc.; *Amgen Inc.; Anonymous donation to the Medical College of Wisconsin; Ariad; Be the Match Foundation; *Blue Cross and Blue Shield Association; *Celgene Corporation; Chimerix, Inc.; Fred Hutchinson Cancer Research Center; Fresenius-Biotech North America, Inc.; *Gamida Cell Teva Joint Venture Ltd.; Genentech Inc.; *Gentium SpA; Genzyme Corporation; GlaxoSmithKline; Health Research Inc. Roswell Park Cancer Institute; HistoGenetics Inc.; Incyte Corporation; Jeff Gordon Children’s Foundation; Kiadis Pharma; The Leukemia & Lymphoma Society; Medac GmbH; The Medical College of Wisconsin; Merck & Co Inc.; Millennium: The Takeda Oncology Co.; *Milliman USA, Inc.; *Miltenyi Biotec, Inc.; National Marrow Donor Program; Onyx Pharmaceuticals; Optum Healthcare Solutions, Inc.; Osiris Therapeutics, Inc.; Otsuka America Pharmaceutical, Inc.; Perkin Elmer, Inc.; *Remedy Informatics; *Sanofi US; Seattle Genetics; Sigma-Tau Pharmaceuticals; Soligenix, Inc.; St. Baldrick’s Foundation; StemCyte, A Global Cord Blood Therapeutics Co.; Stemsoft Software, Inc.; Swedish Orphan Biovitrum; *Tarix Pharmaceuticals; *TerumoBCT; *Teva Neuroscience, Inc.; *THERAKOS, Inc.; University of Minnesota; University of Utah; and *Wellpoint, Inc. The views expressed in this article do not reflect the official policy or position of the National Institute of Health, the Department of the Navy, the Department of Defense, Health Resources and Services Administration (HRSA) or any other agency of the U.S. Government. *Corporate members.

Funders	Funder number
Office of Naval Research Naval Academy
U.S. Department of Health and Human Services	N00014-13-1-0039, N00014-12-1-0142
National Heart, Lung, and Blood Institute (NHLBI)	U10HL069291
National Childhood Cancer Registry – National Cancer Institute
National Institute of Allergy and Infectious F32-AI286447 Cydney N. Johnson Diseases National Institute of Allergy and Infectious R01AI168214 Jason W. Rosch Diseases National Institute of Allergy and Infectious P30 Cydney N. Johnson Diseases National Institute of Allergy and Infectious R00-AI166116 Christopher D. Radka Diseases National Institute of Allergy and Infectious T32-AI106700 Cydney N. Johnson Diseases National Institute of Allergy and Infectious R01AI192221 Jason W. Rosch Diseases National Inst...	HHSH250201200016C, 5U10HL069294
Health Resources and Services Administration
National Institute for Health Research Health Protection Research Unit
Allos Therapeutics
Actinium Pharmaceuticals Incorporated

ASJC Scopus subject areas

Hematology
Transplantation

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10.1038/bmt.2014.259

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Bachanova, V., Burns, L. J., Wang, T., Carreras, J., Gale, R. P., Wiernik, P. H., Ballen, K. K., Wirk, B., Munker, R., Rizzieri, D. A., Chen, Y. B., Gibson, J., Akpek, G., Costa, L. J., Kamble, R. T., Aljurf, M. D., Hsu, J. W., Cairo, M. S., Schouten, H. C., ... Saber, W. (2015). Alternative donors extend transplantation for patients with lymphoma who lack an HLA matched donor. Bone Marrow Transplantation, 50(2), 197-203. https://doi.org/10.1038/bmt.2014.259

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title = "Alternative donors extend transplantation for patients with lymphoma who lack an HLA matched donor",

abstract = "Alternative donor transplantation is increasingly used for high-risk lymphoma patients. We analyzed 1593 transplant recipients (2000-2010) and compared transplant outcomes in recipients of 8/8 allele HLA-A, -B, -C and DRB1 matched unrelated donors (MUDs; n=1176), 7/8 allele HLA mismatched unrelated donors (MMUDs; n=275) and umbilical cord blood donors (1 or 2 units UCB; n=142). Adjusted 3-year non-relapse mortality of MMUD (44\%) was higher as compared with MUD (35\%; P=0.004), but similar to UCB recipients (37\%; P=0.19), although UCB had lower rates of neutrophil and platelet recovery compared with unrelated donor groups. With a median follow-up of 55 months, 3-year adjusted cumulative incidence of relapse was lower after MMUD compared with MUD (25\% vs 33\%, P=0.003) but similar between UCB and MUD (30\% vs 33\%; P=0.48). In multivariate analysis, UCB recipients had lower risks of acute and chronic GVHD compared with adult donor groups (UCB vs MUD: hazard ratio (HR)=0.68, P=0.05; HR=0.35; P<0.001). Adjusted 3-year OS was comparable (43\% MUD, 37\% MMUD and 41\% UCB). These data highlight the observation that patients with lymphoma have acceptable survival after alternative donor transplantation. MMUD and UCB can extend the curative potential of allotransplant to patients who lack suitable HLA matched sibling or MUD.",

author = "V. Bachanova and Burns, \{L. J.\} and T. Wang and J. Carreras and Gale, \{R. P.\} and Wiernik, \{P. H.\} and Ballen, \{K. K.\} and B. Wirk and R. Munker and Rizzieri, \{D. A.\} and Chen, \{Y. B.\} and J. Gibson and G. Akpek and Costa, \{L. J.\} and Kamble, \{R. T.\} and Aljurf, \{M. D.\} and Hsu, \{J. W.\} and Cairo, \{M. S.\} and Schouten, \{H. C.\} and U. Bacher and Savani, \{B. N.\} and Wingard, \{J. R.\} and Lazarus, \{H. M.\} and Laport, \{G. G.\} and S. Montoto and Maloney, \{D. G.\} and Smith, \{S. M.\} and C. Brunstein and W. Saber",

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Bachanova, V, Burns, LJ, Wang, T, Carreras, J, Gale, RP, Wiernik, PH, Ballen, KK, Wirk, B, Munker, R, Rizzieri, DA, Chen, YB, Gibson, J, Akpek, G, Costa, LJ, Kamble, RT, Aljurf, MD, Hsu, JW, Cairo, MS, Schouten, HC, Bacher, U, Savani, BN, Wingard, JR, Lazarus, HM, Laport, GG, Montoto, S, Maloney, DG, Smith, SM, Brunstein, C & Saber, W 2015, 'Alternative donors extend transplantation for patients with lymphoma who lack an HLA matched donor', Bone Marrow Transplantation, vol. 50, no. 2, pp. 197-203. https://doi.org/10.1038/bmt.2014.259

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T1 - Alternative donors extend transplantation for patients with lymphoma who lack an HLA matched donor

AU - Bachanova, V.

AU - Burns, L. J.

AU - Wang, T.

AU - Carreras, J.

AU - Gale, R. P.

AU - Wiernik, P. H.

AU - Ballen, K. K.

AU - Wirk, B.

AU - Munker, R.

AU - Rizzieri, D. A.

AU - Chen, Y. B.

AU - Gibson, J.

AU - Akpek, G.

AU - Costa, L. J.

AU - Kamble, R. T.

AU - Aljurf, M. D.

AU - Hsu, J. W.

AU - Cairo, M. S.

AU - Schouten, H. C.

AU - Bacher, U.

AU - Savani, B. N.

AU - Wingard, J. R.

AU - Lazarus, H. M.

AU - Laport, G. G.

AU - Montoto, S.

AU - Maloney, D. G.

AU - Smith, S. M.

AU - Brunstein, C.

AU - Saber, W.

PY - 2015/2/7

Y1 - 2015/2/7

N2 - Alternative donor transplantation is increasingly used for high-risk lymphoma patients. We analyzed 1593 transplant recipients (2000-2010) and compared transplant outcomes in recipients of 8/8 allele HLA-A, -B, -C and DRB1 matched unrelated donors (MUDs; n=1176), 7/8 allele HLA mismatched unrelated donors (MMUDs; n=275) and umbilical cord blood donors (1 or 2 units UCB; n=142). Adjusted 3-year non-relapse mortality of MMUD (44%) was higher as compared with MUD (35%; P=0.004), but similar to UCB recipients (37%; P=0.19), although UCB had lower rates of neutrophil and platelet recovery compared with unrelated donor groups. With a median follow-up of 55 months, 3-year adjusted cumulative incidence of relapse was lower after MMUD compared with MUD (25% vs 33%, P=0.003) but similar between UCB and MUD (30% vs 33%; P=0.48). In multivariate analysis, UCB recipients had lower risks of acute and chronic GVHD compared with adult donor groups (UCB vs MUD: hazard ratio (HR)=0.68, P=0.05; HR=0.35; P<0.001). Adjusted 3-year OS was comparable (43% MUD, 37% MMUD and 41% UCB). These data highlight the observation that patients with lymphoma have acceptable survival after alternative donor transplantation. MMUD and UCB can extend the curative potential of allotransplant to patients who lack suitable HLA matched sibling or MUD.

AB - Alternative donor transplantation is increasingly used for high-risk lymphoma patients. We analyzed 1593 transplant recipients (2000-2010) and compared transplant outcomes in recipients of 8/8 allele HLA-A, -B, -C and DRB1 matched unrelated donors (MUDs; n=1176), 7/8 allele HLA mismatched unrelated donors (MMUDs; n=275) and umbilical cord blood donors (1 or 2 units UCB; n=142). Adjusted 3-year non-relapse mortality of MMUD (44%) was higher as compared with MUD (35%; P=0.004), but similar to UCB recipients (37%; P=0.19), although UCB had lower rates of neutrophil and platelet recovery compared with unrelated donor groups. With a median follow-up of 55 months, 3-year adjusted cumulative incidence of relapse was lower after MMUD compared with MUD (25% vs 33%, P=0.003) but similar between UCB and MUD (30% vs 33%; P=0.48). In multivariate analysis, UCB recipients had lower risks of acute and chronic GVHD compared with adult donor groups (UCB vs MUD: hazard ratio (HR)=0.68, P=0.05; HR=0.35; P<0.001). Adjusted 3-year OS was comparable (43% MUD, 37% MMUD and 41% UCB). These data highlight the observation that patients with lymphoma have acceptable survival after alternative donor transplantation. MMUD and UCB can extend the curative potential of allotransplant to patients who lack suitable HLA matched sibling or MUD.

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Alternative donors extend transplantation for patients with lymphoma who lack an HLA matched donor

Abstract

Bibliographical note

Funding

ASJC Scopus subject areas

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