Combined haploidentical-cord stem cell transplantation in lymphoma and CLL – what are the outcomes?

This study analyzed the outcomes of lymphoma and chronic lymphoblastic leukemia (CLL) patients who received haplo-cord stem cell transplantation. The study concluded that this method gives higher rates of engraftment and lower rates of graft-versus-host disease (GVHD) compared to haploidentical transplant.

High-risk lymphoma patients with relapsing or unresponsive (refractory) disease may be candidates for allogeneic stem cell transplantation (SCT). This procedure requires a close tissue type match between the donor and the patient, such as a sibling. 

70% of patients don’t have an exact tissue type match. For these patients, haploidentical transplantation can achieve a 50% match. This makes it easier to find donors, helping treat patients more quickly. Stem cells from umbilical cord blood can also be used, but these cells take a long time to restore white blood cell counts. This increases hospitalization time and care costs. Combining these methods could provide the best of both: faster white blood cell recovery with a lower risk of graft-versus-host disease (GVHD, when the transplanted cells attack healthy tissue).

This study involved 42 patients with a range of lymphomas, both non-Hodgkin’s or Hodgkin’s, or CLL. 29% of patients were in complete remission, while 71% had active disease. 57% of patients were at high or very high risk. 52% of patients had received three or more lines of therapy prior to the transplant procedure.

By 60 days post-transplant, 100% of patients had white blood cell recovery, and 91% of patients had platelet (blood cells involved in clotting) count recovery. 21% of patients developed acute GHVD, with an 8% occurrence of chronic GHVD at 1 year. 28% of patients experienced disease progression or relapse, with a 19.5% occurrence of relapse at 1 year. Overall, CLL and follicular lymphoma (FL) patients had the best outcomes, staying in remission.

At an average follow-up of 42 months, the rate of relapse-free survival (time from treatment until disease return) was 53%. Progression-free survival (time from treatment until disease progression) was 62%, and overall survival (time from treatment until death from any cause) was 65%.

Epstein-Barr virus (EBV) reactivation occurred in 31%. Cytomegalovirus (CMV) reactivation occurred in 36%. Both were easily controlled with treatment. 

This study concluded that combined haploidentical cord transplant provides fast white blood cell recovery and low rates of GVHD, making it a good alternative treatment for patients with high-risk, relapsed, or refractory lymphomas.

This study only had 42 patients, which is a very small sample size. T-cell and Hodgkin’s lymphoma represented the two largest groups of patients (31% and 21%), but more studies with larger patient populations are needed for comparison.

If you have relapsed or refractory lymphoma, talk to your care team about a combined haploidentical cord transplant as an alternative treatment option.