Novel transplantation methods are improving outcomes among patient with lymphoid malignancies, according to an article published in the Journal of Clinical Oncology.1
While drug discovery is dramatically improving survival rates among patients with varying types of lymphoma, about 1000 patients per year undergo allogeneic transplantation, with varying outcomes depending on method. While human leukocyte antigen (HLA)-identical sibling or unrelated donors were previously critical for successful transplantation, increased genomic heterogeneity across populations have heightened the need for alternatives.
Alternative donor transplantation, which can work across HLA barriers, is an increasingly used option, particularly among patients with relapsed disease. Stem cells from partially matched, unrelated umbilical cord blood (UCB) donors, and from partially matched
family donors, known as haploidentical, are increasingly common sources for engraftment, but they can yield varying results.
Research suggests, however, that outcomes with alternative donor transplantation are approaching those seen with traditional methods. The authors of an article published in the Journal of Clinical Oncology report expected transplantation outcomes, which contrast the 4 transplantation methods: HLA-identical sibling, HLA-identical unrelated donor, haploidentical donor, and UCB.
The estimated donor availability for HLA identical sibling, HLA-identical unrelated donor, haploidentical donor, and UCB were approximately 20%, 15%-75% depending on ethnicity, 80%, and 85%, respectively, based on previously reported data; expected neutrophil recovery time was 10 to 15 days, 10 to 15 days, 15 to 20 days, and 20 to 30 days, respectively.
While expected 3-year overall survival was reportedly lowest among those undergoing UCB transplantation (43.7%), and highest among those in the HLA-identical sibling group (54.6%), those in the UCB group were also the least likely to have a relapse (28.7% vs 36.8% in the HLA-identical sibling group.
The 3-year non-relapse mortality rates in the HLA identical sibling, HLA-identical unrelated donor, haploidentical donor, and UCB groups were 18.1%, 24.8%, 27.3%, and 33%, respectively.
“It is likely that some of these approaches will further improve outcomes and that the trend toward improved access to allogeneic transplantation will continue for the foreseeable future,” the authors concluded.
van Besien KW, Orfali N. Alternative donor transplantation for lymphoid malignancies: how far we have come [published online March 6, 2020]. J Clin Oncol. doi: 10.1200/JCO.20.00177