Umbilical cord blood transplantation in adults with advanced hodgkin's disease: high incidence of post‐transplant lymphoproliferative disease |
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| Authors: | José Luis Piñana Jaime Sanz Albert Esquirol Rodrigo Martino Alessandra Picardi Pere Barba Rocio Parody Jorge Gayoso Pau Montesinos Stefano Guidi Maria José Terol Federico Moscardó Carlos Solano William Arcese Miguel A. Sanz Jorge Sierra Guillermo Sanz GETH GITMO groups |
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| Affiliation: | 1. Department of Hematology, Hospital Clínico Universitario, Fundación INCLIVA, Valencia, Spain;2. Department of Hematology, Hospital Universitario La Fe, Valencia, Spain;3. Department of Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain;4. Rome Transplant Network, UOC Trapianto di Cellule Staminali, Università di Roma Tor Vergata, Rome, Italy;5. Department of Hematology, Hospital Universitari Vall D'Hebron, Barcelona, Spain;6. Department of Clinical Hematology, Hospital Virgen del Rocio, Sevilla, Spain;7. Department of Hematology, Hospital Gregorio Mara?on, Madrid, Spain;8. Bone Marrow Transplant Unit, Department of Hematology, AOU Careggi, Florence, Italy;9. Medicine Department, Universitat de Valencia, Valencia, Spain;10. Hospital de la Santa Creu i Sant Pau, IIB Sant Pau and Jose Carreras Leukemia Research Institute, Universidad Autónoma de Barcelona, Barcelona, Spain |
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| Abstract: | We report the outcome of 30 consecutive patients with Hodgkin disease (HD) who underwent single‐unit UCBT. Most (90%) patients had failed previous autologous hematopoietic stem cell transplantation. The conditioning regimens were based on combinations of thiotepa, busulfan, cyclophosphamide or fludarabine, and antithymocyte globulin. The cumulative incidence (CI) of myeloid engraftment was 90% [95% confidence interval (C.I.), 74–98%] with a median of 18 d (range, 10–48). CI of acute graft‐versus‐host disease (GvHD) grades II–IV was 30% (95% C.I., 17–44%), while the incidence of chronic GVHD was 42% (95% C.I., 23–77%). The non‐relapse mortality (NRM) at 100 d and 4 yr was 30% (95% C.I., 13–46%) and 47% (95% C.I., 29–65%), respectively. EBV‐related post‐transplant lymphoproliferative disease (EBV‐PTLD) accounted for more than one‐third of transplant‐related death, with an estimate incidence of 26% (95% C.I., 9–44). The incidence of relapse at 4 yr was 25% (95% C.I., 9–42%). Four‐year event‐free survival (EFS) and overall survival (OS) were 28% and 30%, respectively. Despite a high NRM and an unexpected high incidence of EBV‐PTLD, UCBT in heavily pretreated HD patients is an option for patients lacking a suitable adult donor, provided the disease is not in refractory relapse. |
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| Keywords: | Hodgkin's disease umbilical cord blood transplantation Hodgkin's lymphoma EBV post‐transplant lymphoproliferative disease |
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