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Haploidentical transplantation with post-transplant cyclophosphamide versus single cord blood transplantation in adults with relapsed/refractory non-Hodgkin lymphoma

Bone Marrow Transplantation volume 59, pages 1735–1743 (2024)Cite this article

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Abstract

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a curative treatment for relapsed or refractory non-Hodgkin lymphoma (R/R NHL). Allo-HSCT using post-transplant cyclophosphamide (PTCY-haplo) and umbilical cord blood transplantation (uCBT) are important donor options in the absence of matched related siblings. However, the data comparing these two donor sources in R/R NHL are limited. Using the Japanese nationwide transplantation registry data, we identified 857 patients with R/R NHL, including 169 patients who received PTCY-haplo and 688 who received uCBT for their first allo-HSCT between January 2013 and December 2021; 514 patients (60%) had B-cell lymphoma. More PTCY-haplo recipients received allo-HSCT using a reduced-intensity conditioning regimen in recent years. The 3-year overall survival (OS), progression-free survival (PFS), and graft-versus-host disease (GVHD)-free/relapse-free survival (GRFS) rates in the PTCY-haplo and uCBT groups were 44% versus 39% (P = 0.326), 34% versus 33% (P = 0.660), and 19% versus 23% (P = 0.910), respectively; the adjusted hazard ratios for OS, PFS, and GRFS were 0.89 (95% confidence interval: 0.69–1.15, P = 0.373), 0.98 (0.78–1.22, P = 0.852), and 0.92 (0.83–1.21, P = 0.920), respectively. The PTCY-haplo group showed faster neutrophil and platelet engraftment and a lower incidence of grade III-IV acute GVHD. Thus, PTCY-haplo and uCBT could serve as alternative donor sources in patients with R/R NHL.

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Fig. 1: Survival outcomes, relapse or progression, and non-relapse mortality by donor type.
Fig. 2: Hematopoietic engraftment and graft-versus-host disease (GVHD).

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Data availability

The data used in this study are not publicly available due to ethical restrictions, as this would exceed the scope of the recipient/donor consent for research use in the registry. However, data may be available from the corresponding author upon reasonable request and with permission of the Japanese Society for Transplantation and Therapy (JSTCT)/ Japanese Data Center for Hematopoietic Cell Transplantation (JDCHCT).

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Acknowledgements

The authors thank the physicians and data managers at the transplant centers who provided clinical data to the TRUMP2 database of the JDCHCT.

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Authors and Affiliations

  1. Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan

    Masashi Nishikubo, Yoshimitsu Shimomura & Nobuhiro Hiramoto

  2. Department of Hematology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan

    Yosuke Nakaya

  3. Department of Hematology, Tokyo Women’s Medical University, Tokyo, Japan

    Akihito Shinohara

  4. Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations, Toranomon Hospital, Tokyo, Japan

    Naoyuki Uchida

  5. Department of Hematology, Kyorin University Faculty of Medicine, Mitaka-shi, Japan

    Nobuyuki Takayama

  6. Department of Hematology, Nagano Red Cross Hospital, Nagano, Japan

    Hikaru Kobayashi

  7. Department of Hematology, Kitakyushu City Hospital Organization, Kitakyushu Municipal Medical Center, Kitakyushu, Japan

    Yasufumi Uehara

  8. Department of Hematology, Osaka International Cancer Institute, Osaka, Japan

    Jun Ishikawa

  9. Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations, Toranomon Hospital, Kajigaya, Japan

    Kazuya Ishiwata

  10. Department of Hematology and Medical Oncology, Shinshu University School of Medicine, Nagano, Japan

    Hideyuki Nakazawa

  11. Division of Hematology, Department of Medicine, Keio University School of Medicine, Keio, Japan

    Keisuke Kataoka

  12. Department of Hematology, Kyoto University Hospital, Kyoto, Japan

    Junya Kanda

  13. Division of Hematology and Oncology, Department of Medicine, Kurume University Hospital, Kurume, Fukuoka, Japan

    Koji Nagafuji

  14. Department of Hematology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan

    Yasuji Kozai

  15. Department of Hematology, Kawasaki Medical School, Kurashiki, Japan

    Yoshiko Matsuhashi & Eisei Kondo

  16. Technical Department, Japanese Red Cross Society Blood Service Headquarters, Tokyo, Japan

    Fumihiko Ishimaru

  17. Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan

    Sung-Won Kim & Takahiro Fukuda

  18. Division of Hematology, Jichi Medical University, Shimotsuke, Tochigi, Japan

    Yoshinobu Kanda

  19. Japanese Data Center For Hematopoietic Cell Transplantation, Tokyo, Japan

    Yoshiko Atsuta

  20. Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Tokyo, Japan

    Yoshiko Atsuta

  21. Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan

    Shinichi Kako

Authors
  1. Masashi Nishikubo
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  2. Yoshimitsu Shimomura
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  3. Yosuke Nakaya
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  5. Naoyuki Uchida
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  6. Nobuyuki Takayama
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  7. Hikaru Kobayashi
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  8. Yasufumi Uehara
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  9. Jun Ishikawa
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  10. Kazuya Ishiwata
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  11. Nobuhiro Hiramoto
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  12. Hideyuki Nakazawa
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  13. Keisuke Kataoka
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  14. Junya Kanda
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  15. Koji Nagafuji
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  16. Yasuji Kozai
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  17. Yoshiko Matsuhashi
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  18. Fumihiko Ishimaru
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  19. Sung-Won Kim
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  20. Takahiro Fukuda
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  21. Yoshinobu Kanda
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  22. Yoshiko Atsuta
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  23. Eisei Kondo
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  24. Shinichi Kako
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Contributions

MN and YS initiated the trial, designed the study, and analyzed the data. MN wrote the paper and YS supervised the statistical analysis and manuscript writing, editing, and review. YN, AS, NU, NT, HK, YU, JI, KI, NH, HN, KK, JK, NK, YZ, YM, FI, SK, TF, YK, YA, EK, and SK interpreted the results and critically reviewed the manuscript. All authors contributed to data collection and approved the final version of the manuscript.

Corresponding author

Correspondence to Masashi Nishikubo.

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Competing interests

The authors declare no competing interests.

Ethics approval statement

This study was approved by the Japanese Data Center for Hematopoietic Cell Transplantation (JDCHCT) and Institutional Review Board of Kobe City Medical Center General Hospital and was conducted in accordance with the Declaration of Helsinki (approval number: zn230805).

Informed consent

Written informed consent was obtained from all patients prior to TRUMP2 registration.

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Nishikubo, M., Shimomura, Y., Nakaya, Y. et al. Haploidentical transplantation with post-transplant cyclophosphamide versus single cord blood transplantation in adults with relapsed/refractory non-Hodgkin lymphoma. Bone Marrow Transplant 59, 1735–1743 (2024). https://doi.org/10.1038/s41409-024-02423-y

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