Results of Allogeneic Double Umbilical Cord Blood Transplantation for Relapsed and Refractory Hodgkin Lymphoma

Introduction: Allogeneic hematopoietic cell transplantation is effective in patients (pts) with high-risk lymphoid malignancies including Hodgkin lymphoma (HL). We studied 27 pts who received double umbilical cord blood transplant (dUCBT) at The UT M.D. Anderson Cancer Center or The Royal Melbourne Hospital, Australia for relapsed/refractory HL.

Patients and Methods: Median number of prior treatments was 4 (range 2-6); 25 of 27 had had prior autologous transplant. 45% did not achieve at least partial response to their most recent prior therapy and 26% had progressive disease. Pts were treated consecutively between Aug 2003 and May 2014. All pts received dUCBT from 4/6-6/6 matched cord blood units. Graft versus host disease (GVHD) prophylaxis was tacrolimus or cyclosporine plus low dose methotrexate or mycophenolate mofetil. Pts were treated on ex-vivo expansion studies using liquid culture media (N=8), mesenchymal stromal cells (N=3) or fucosylation (N=3) as available.

Results: Pt and transplant characteristics are described in table 1. All pts engrafted. Median time to neutrophil recovery (ANC > 500/mm³) was 17 days (range: 5-38). Median follow-up after transplant was 14 months. Cumulative incidences of grade II acute GVHD and extensive chronic GVHD were 33.5% (95% CI 18.8-52.4) and 40.5% (24.7-59.6), respectively. No pt developed grade III-IV acute GVHD. Sixteen of 27 pts achieved complete remission (CR) after alloHCT; 7 had progressive disease at a median time of 7.4 months post-transplant (range 4.1-36.0). At the time of last follow up 16 of 27 pts were alive. Relapse contributed to death in 3 pts. The 5-year cumulative incidence of non-relapse mortality (NRM) was 37.9% (95% CI: 20.9-59.0). Five year probabilities of progression free-survival (PFS), and overall survival (OS) were 31.3 (95% CI: 15.0-54.0) and 47.9 (95% CI: 26.2-70.5), respectively (Figure). Small numbers limited the ability to define prognostic factors; however there was a trend toward inferior survival in pts achieving less than PR to their most recent prior treatment (p=0.12).

Conclusions: dUCBT is effective for patients with advanced HL. Relapse rate was low and approximately 30% of pts achieve long-term disease-free survival, including pts with chemorefractory disease prior to dUCBT.