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Combined Haploidentical and Umbilical Cord Blood Allogeneic Stem Cell Transplantation for High-Risk Lymphoma and CLL
Hsu, J., Artz, A., Mayer, S. A., Guarner, D., Bishop, M. R., Reich-Slotky, R., Smith, S. M., Greenberg, J., Kline, J., Ferrante, R., et al
Biology of Blood & Marrow Transplantation. 2017
Abstract
Limited studies have reported on outcomes for lymphoid malignancy patients receiving alternative donor allogeneic stem cell transplants. We have previously described combining CD34-selected haploidentical grafts with umbilical cord blood (haplo-cord) to accelerate neutrophil and platelet engraftment. Here, we examine the outcome of patients with lymphoid malignancies undergoing haplo-cord transplantation at the University of Chicago and Weill Cornell Medical College. We analyzed 42 lymphoma and CLL patients who underwent haplo-cord allogeneic stem cell transplantation. Patients underwent transplant for Hodgkin's lymphoma (n=9, 21%), CLL (n=5, 12%) and non-Hodgkin lymphomas (n=28, 67%), including 13 T-cell lymphoma. Twenty four patients (52%) had 3 or more lines of therapies. Six (14%) and one (2%) patients had prior autologous and allogeneic stem cell transplant, respectively. At the time of transplant, 12 patients (29%) were in complete remission (CR), 18 had chemotherapy-sensitive disease and 12 patients had chemotherapy-resistant disease. Seven (17%), 11 (26%) and 24 (57%) patients had low, intermediate and high disease risk index (DRI) prior to transplant. Comorbidity index was evenly distributed among 3 groups with 13 (31%), 14 (33%) and 15(36%) patients scored 0, 1-2 and >=3. Median age for the cohort was 49 years (23-71). All patients received fludarabine/melphalan/ATG conditioning regimen and post-transplant GVHD prophylaxis with tacrolimus and mycophenolate mofetil (MMF). The median time to neutrophil engraftment was 11 days (9-60) and to platelet engraftment was 19.5 days (11-88). Cumulative Incidence of non-relapse mortality (NRM) was 11.6% at 100 days and 19 % at one year. Cumulative incidence of relapse was 9.3% at 100 days and 19% at one year. With a median follow up of survivors of 42 months, the three-year GVHD/Progression Free Survival (GPFS), progression free survival (PFS) and overall survival (OS) was 53%, 62%, and 65% respectively for these patients. Only 8% of the survivors have chronic GVHD. In conclusion, haplo-cord transplantation offers a transplant alternative for patients with recurrent or refractory lymphoid malignancies who lack matching donors. Both neutrophil and platelet count recovery is rapid, non-relapse mortality is limited, excellent disease control can be achieved and the incidence of chronic GVHD is limited. Thus, haplo-cord achieves high rates of engraftment and encouraging results. Copyright © 2017. Published by Elsevier Inc.