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Excellent Clinical Outcome for Relapsed and Refractory Lymphoma Patients with Haplo-Cord Allogeneic Stem Cell Transplantation

Jingmei Hsu, Andrew Artz, Sebastian A. Mayer, Michael R. Bishop, Adrienne A. Phillips, Sonali M. Smith, Usama Gergis, Justin Kline, Tsiporah B. Shore and Koen van Besien

Abstract

Background:

Umbilical cord blood transplantation has been used for hematologic malignancy patients lacking matching donors but slow engraftment has hindered its wide usage. We have previously described combining CD34 selected -haploidentical grafts with umbilical cord cells to accelerate neutrophil and platelet engraftment Here, we examine the outcome of patients with lymphoid malignancies undergoing haplo-cord transplantation at the University of Chicago and Weill Cornell Medical College from May 2008 to February 2016.

Results:

Median age was 45 years (23-69). 9 (23%) pts had Hodgkin's lymphoma, 5 (13%) patients had CLL and 25 (64%) patients had non-Hodgkin lymphoma including 6 T-NHL. Five (13%) and 1(2%) patient had prior autologous and allogeneic stem cell transplant respectively. Three (7%), 18 (46%) and 18 (46%) patients has low, intermediate and high/very high CIBMTR disease risk index prior to transplant. All patients received fludarabine/melphalan/ATG conditioning regimen and post-transplant GVHD prophylaxis with tacrolimus and MMF. The median time to neutrophil engraftment is 11 days (9-60) and platelet engraftment is 19 days (11-88).

Cumulative Incidence of NRM is 10% at 100 days and 16 % at one year. Cumulative incidence of relapse is 15% at 100days and 18% at one year. With a median follow up for survivors of 18 months, one year overall survival (OS) is 73% (95% CI 59-87). OS at one year is 58% for NHL patients, 80 % for HL patients and 100 % for patients with CLL. None of the survivors have chronic GVHD.

Conclusion:

HaploCord Transplantation offers an excellent treatment alternative for patients with recurrent and refractory lymphoid malignancies who lack matching donors. Count recovery is rapid, non relapse mortality is limited, excellent disease control can be achieved and the incidence of chronic GVHD is limited.

Disclosures Smith: Celgene: Consultancy; Juno: Consultancy; TGTX: Consultancy; Portola: Consultancy; Amgen: Other: Educational lecture to sales force; AbbVie: Consultancy; Gilead: Consultancy; Pharmacyclics: Consultancy; Genentech: Consultancy, Other: on a DSMB for two trials . Kline: Merck: Honoraria, Research Funding; Vasculox: Research Funding.

  • * Asterisk with author names denotes non-ASH members.