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3607 Haploidentical Transplantation with Post-Transplant Cyclophosphamide Versus Single Cord Blood Transplantation for Adults with Relapsed/Refractory Malignant Lymphoma

Program: Oral and Poster Abstracts
Session: 732. Allogeneic Transplantation: Disease Response and Comparative Treatment Studies: Poster II
Hematology Disease Topics & Pathways:
Biological therapies, Lymphomas, non-Hodgkin lymphoma, B Cell lymphoma, T Cell lymphoma, Diseases, indolent lymphoma, aggressive lymphoma, Therapies, Lymphoid Malignancies, Transplantation
Sunday, December 10, 2023, 6:00 PM-8:00 PM

Masashi Nishikubo, MD1*, Yoshimitsu Shimomura2*, Yosuke Nakaya3*, Akihito Shinohara4*, Naoyuki Uchida, MD, PhD5, Nobuyuki Takayama, MD, PhD6, Hikaru Kobayashi7*, Yasufumi Uehara8*, Jun Ishikawa9*, Kazuya Ishiwata, M.D., Ph.D.10*, Nobuhiro Hiramoto2*, Hideyuki Nakazawa, MD, PhD11*, Fumihiko Ishimaru12*, Takahiro Fukuda, MD, PhD13*, Yoshinobu Kanda14*, Yoshiko Atsuta, MD, PhD15*, Eisei Kondo, MD, PhD16* and Shinichi Kako, MD, PhD14

1Department of Hematology, Kobe City Medical Center General Hospital, Kobe, HYO, Japan
2Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
3Department of Hematology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
4Department of Hematology, Tokyo Women's Medical University, Tokyo, Japan
5Department of Hematology, Toranomon Hospital, Tokyo, Japan
6Department of Hematology, Kyorin University Faculty of Medicine, Mitaka, Japan
7Department of Hematology, Nagano Red Cross Hospital, Nagano, Japan
8Department of Hematology, Kitakyushu City Hospital Organization, Kitakyushu Municipal Medical Center, Kitakyushu, Japan
9Department of Hematology, Osaka International Cancer Institute, Osaka, Japan
10Department of Hematology, Toranomon Hospital Kajigaya, Kanagawa, Japan
11Department of Hematology and Medical Oncology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
12Japanese Red Cross Kanto-Koshinetsu Block Blood Center, Tokyo, Japan
13Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
14Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
15Japanese Data Center For Hematopoietic Cell Transplantation, Nagakute, Japan
16Department of Hematology, Kawasaki Medical School, Kurashiki, Japan


Although the treatment of malignant lymphoma has diversified with the advent of chimeric antigen receptor T-cell therapy and other novel agents, allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains a curative treatment for some patients with relapsed/refractory malignant lymphoma (R/R ML). R/R ML eligible for allo-HSCT often requires urgent transplantation, making human leukocyte antigen (HLA)-haploidentical transplantation with post-transplant cyclophosphamide (PTCY-haplo) or cord blood transplantation (CBT) a promising option when HLA-matched donors are unavailable. PTCY-haplo has recently been reported to achieve similar or better clinical outcomes than CBT for other hematological malignancies, though data regarding R/R ML are insufficient. Therefore, this study compares PTCY-haplo and CBT for patients with R/R ML using the Transplant Registry Unified Management Program 2 (TRUMP2) in Japan.


This study included adult patients with R/R ML registered with TRUMP2 who underwent PTCY-haplo and CBT for their first allo-HSCT between January 2013 and December 2021. In this study, R/R ML included mature B-, T-, and NK-cell neoplasms, as defined in the World Health Organization’s 2017 classification. Patients undergoing allo-HSCT for Hodgkin’s lymphoma, aggressive NK-cell leukemia, chronic active Epstein-Barr virus (EBV) infection, systemic EBV-positive T-cell lymphoma of childhood, or adult T-cell leukemia/lymphoma were excluded. The primary endpoint was 3-year overall survival (OS). A Cox proportional hazard regression model for OS was used to estimate hazard ratios (HR) with 95% confidence intervals (CI) in the multivariate analysis. The following factors were included in the multivariate model: donor type, age, sex, performance status, Hematopoietic Cell Transplantation-specific Comorbidity Index score, disease status at allo-HSCT, conditioning regimen, cytomegalovirus seropositivity, and disease linage. The secondary endpoints were 3-year progression-free survival (PFS), 3-year graft versus host disease (GVHD)/relapse-free survival (GRFS), 3-year cumulative incidence of relapse and non-relapse mortality (NRM), 28-day cumulative incidence of neutrophil engraftment, 100-day cumulative incidence of platelet engraftment, 100-day cumulative incidence of grade II-IV and grade III-IV acute GVHD, and 3-year cumulative incidence of any and extensive chronic GVHD.


A total of 1093 patients, including 223 who underwent PTCY-haplo and 870 who underwent CBT, were included in the study. The median age was 54 years (interquartile range, 44-61 years), and 616 (56%) patients had B-cell lymphoma. The PTCY-haplo group included older patients, more patients who were positive for cytomegalovirus antibodies in recipients or donors, and more patients who received a reduced-intensity conditioning regimen. The 3-year OS was 49% (95% CI: 41-56%) in the PTCY-haplo group and 42% (95% CI: 38-45%) in the CBT group (P=0.090). The adjusted HR was 0.88 (95% CI: 0.70-1.09, P=0.20). The PTCY-haplo group had comparable 3-year PFS, 3-year GRFS, 3-year relapse rates, and 3-year NRM as the CBT group. The PTCY-haplo group had higher neutrophil engraftment at 28 days (92.8% [95%CI: 88.5-95.6%] vs 81.6% [95%CI: 78.9-84.0%], P<0.001) and platelet engraftment at 100 days (77.6% [95%CI: 71.5-82.5%] vs 71.0% [95%CI: 67.9-73.9%], P<0.001); similar grade II-IV acute GVHD at 100 days and 3-year cumulative incidences of chronic GVHD and extensive chronic GVHD; and lower grade III-IV acute GVHD at 100 days (7.17% [95%CI: 4.27-11.1%] vs 13.6% [95%CI 11.5-16.0], P=0.01).


In this population, PTCY-haplo and CBT result in similar 3-year OS after allo-HSCT. Faster engraftment and less severe acute GVHD were noted in the PTCY-haplo group.

Disclosures: Takayama: Janssen Pharmaceutical: Honoraria; Nippon Shinyaku: Honoraria; Celgene: Honoraria; SymBio Pharmaceuticals: Honoraria; Eisai: Honoraria; Asahi Kasei: Honoraria, Research Funding; Takeda: Honoraria, Research Funding; Chugai Pharma: Honoraria, Research Funding; Kyowa Kirin: Honoraria, Research Funding; Bristol Myers Squibb: Honoraria. Kanda: AbbVie: Research Funding, Speakers Bureau; Towa Pharma: Speakers Bureau; CSL Behring: Speakers Bureau; Japan Blood Products Organization: Research Funding, Speakers Bureau; Otsuka Pharmaceutical: Research Funding, Speakers Bureau; AstraZeneca: Speakers Bureau; Human Life CORD: Speakers Bureau; Sumitomo Pharma: Research Funding, Speakers Bureau; Amgen: Speakers Bureau; Takeda Pharmaceutical: Research Funding, Speakers Bureau; Meiji Seika Pharma: Speakers Bureau; Asahi Kasei Pharma: Research Funding, Speakers Bureau; Daiichi Sankyo: Research Funding, Speakers Bureau; Saitama Hokeni Kyokai: Speakers Bureau; MSD: Speakers Bureau; Kyowa Kirin: Research Funding, Speakers Bureau; Janssen Pharmaceutical: Speakers Bureau; Sanofi: Speakers Bureau; Pfizer: Speakers Bureau; Chugai Pharmaceutical: Research Funding, Speakers Bureau; Novartis: Speakers Bureau; Bristol Myers Squibb: Speakers Bureau; Eisai: Research Funding, Speakers Bureau; Precision: Speakers Bureau; FUJIFILM Wako Pure Chemical: Speakers Bureau; Nippon Shinyaku: Speakers Bureau; Alexion Pharma: Speakers Bureau; Taiho Pharmaceutical: Research Funding; Shionogi Pharma: Research Funding; Wakunaga Pharmaceutical: Speakers Bureau; Nippon Kayaku: Research Funding; JCR Pharmaceuticals: Research Funding. Atsuta: Meiji Seika Pharma Co, Ltd.: Honoraria; CHUGAI PHARMACEUTICAL CO., LTD.: Speakers Bureau; Novartis Pharma KK: Speakers Bureau; Otsuka Pharmaceutical Co., Ltd: Speakers Bureau; JCR Pharmaceuticals Co., Ltd.: Consultancy.

*signifies non-member of ASH