Alternative donors extend transplantation for patients with lymphoma who lack an HLA matched donor.
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.
Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN, USA.
V
V
Bachanova
Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN, USA.
L J
LJ
Burns
1] Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA [2] Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA.
T
T
Wang
Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
J
J
Carreras
Division of Experimental Medicine, Department of Medicine, Hematology Research Center, Imperial College London, London, UK.
R P
RP
Gale
Our Lady of Mercy Medical Center, Bronx, NY, USA.
P H
PH
Wiernik
Department of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, USA.
K K
KK
Ballen
BMT Program, Stony Brook University Medical Center, Stony Brook, NY, USA.
B
B
Wirk
Department of Hematology/Oncology, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
R
R
Munker
Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC, USA.
D A
DA
Rizzieri
Department of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, USA.
Y-B
YB
Chen
Department of Hematology, Royal Prince Alfred Hospital, Camperdown, Australia.
J
J
Gibson
Banner MD Anderson Cancer Center, Gilbert, AZ, USA.
G
G
Akpek
Medical University of South Carolina, Charleston, SC, USA.
L J
LJ
Costa
Department of Hematology/Oncology, Baylor College of Medicine, Houston, TX, USA.
R T
RT
Kamble
Department of Oncology, King Faisal Specialist Hospital, Riyadh, Saudi Arabia.
M D
MD
Aljurf
Shands HealthCare & University of Florida, Gainesville, FL, USA.
J W
JW
Hsu
Department of Pediatrics, New York Medical College, Valhalla, NY, USA.
M S
MS
Cairo
Academische Ziekenhuis Maastricht, Maastricht, Netherlands.
H C
HC
Schouten
1] Department of Stem Cell Transplantation, University of Hamburg, Hamburg, Germany [2] MLL Munich Leukemia Laboratory, Munich, Germany.
U
U
Bacher
Vanderbilt University Medical Center, Nashville, TN, USA.
B N
BN
Savani
1] Shands HealthCare & University of Florida, Gainesville, FL, USA [2] LifeSouth Community Blood Centers, Gainesville, FL, USA.
J R
JR
Wingard
Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA.
H M
HM
Lazarus
Division of BMT, Stanford Hospitals & Clinics, Stanford, CA, USA.
G G
GG
Laport
Department of Haemato-oncology, St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
S
S
Montoto
Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
D G
DG
Maloney
Section of Hematology/Oncology, The University of Chicago, Chicago, IL, USA.
S M
SM
Smith
Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN, USA.
C
C
Brunstein
Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
W
W
Saber
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D064591:Allografts; D002908:Chronic Disease; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000401:mortality / Q000628:therapy; D006680:HLA Antigens; D018380:Hematopoietic Stem Cell Transplantation; D006650:Histocompatibility Testing; D006801:Humans; D008223:Lymphoma / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D015996:Survival Rate; D061349:Unrelated Donors
D006680:HLA Antigens