NYMC Faculty Publications

Alternative Donors Extend Transplantation for Patients With Lymphoma who Lack an HLA Matched Donor

Author Type(s)

Faculty

DOI

10.1038/bmt.2014.259

Journal Title

Bone Marrow Transplantation

First Page

197

Last Page

203

Document Type

Article

Publication Date

2-1-2015

Department

Pediatrics

Keywords

Acute Disease, Adolescent, Adult, Age Factors, Aged, Allografts, Chronic Disease, Disease-Free Survival, Female, Follow-Up Studies, Graft vs Host Disease, HLA Antigens, Hematopoietic Stem Cell Transplantation, Histocompatibility Testing, Humans, Lymphoma, Male, Middle Aged, Risk Factors, Survival Rate, Unrelated Donors

Disciplines

Medicine and Health Sciences

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.

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