Nilanjan Ghosh1, Reem Karmali1, Vanderson Rocha1, Kwang Woo Ahn1, Alyssa DiGilio1, Parameswaran N Hari1, Veronika Bachanova1, Ulrike Bacher1, Parastoo Dahi1, Marcos de Lima1, Anita D'Souza1, Timothy S Fenske1, Siddhartha Ganguly1, Mohamed A Kharfan-Dabaja1, Tim D Prestidge1, Bipin N Savani1, Sonali M Smith1, Anna M Sureda1, Edmund K Waller1, Samantha Jaglowski1, Alex F Herrera1, Philippe Armand1, Rachel B Salit1, Nina D Wagner-Johnston1, Ephraim Fuchs1, Javier Bolaños-Meade1, Mehdi Hamadani2. 1. Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD. 2. Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD. mhamadani@mcw.edu.
Abstract
PURPOSE: Related donor haploidentical hematopoietic cell transplantation (Haplo-HCT) using post-transplantation cyclophosphamide (PT-Cy) is increasingly used in patients lacking HLA-matched sibling donors (MSD). We compared outcomes after Haplo-HCT using PT-Cy with MSD-HCT in patients with lymphoma, using the Center for International Blood and Marrow Transplant Research registry. MATERIALS AND METHODS: We evaluated 987 adult patients undergoing either Haplo-HCT (n = 180) or MSD-HCT (n = 807) following reduced-intensity conditioning regimens. The haploidentical group received graft-versus-host disease (GVHD) prophylaxis with PT-Cy with or without a calcineurin inhibitor and mycophenolate. The MSD group received calcineurin inhibitor-based GVHD prophylaxis. RESULTS: Median follow-up of survivors was 3 years. The 28-day neutrophil recovery was similar in the two groups (95% v 97%; P = .31). The 28-day platelet recovery was delayed in the haploidentical group compared with the MSD group (63% v 91%; P = .001). Cumulative incidence of grade II to IV acute GVHD at day 100 was similar between the two groups (27% v 25%; P = .84). Cumulative incidence of chronic GVHD at 1 year was significantly lower after Haplo-HCT (12% v 45%; P < .001), and this benefit was confirmed on multivariate analysis (relative risk, 0.21; 95% CI, 0.14 to 0.31; P < .001). For Haplo-HCT v MSD-HCT, 3-year rates of nonrelapse mortality (15% v 13%; P = .41), relapse/progression (37% v 40%; P = .51), progression-free survival (48% v 48%; P = .96), and overall survival (61% v 62%; P = .82) were similar. Multivariate analysis showed no significant difference between Haplo-HCT and MSD-HCT in terms of nonrelapse mortality (P = .06), progression/relapse (P = .10), progression-free survival (P = .83), and overall survival (P = .34). CONCLUSION: Haplo-HCT with PT-Cy provides survival outcomes comparable to MSD-HCT, with a significantly lower risk of chronic GVHD.
PURPOSE: Related donor haploidentical hematopoietic cell transplantation (Haplo-HCT) using post-transplantation cyclophosphamide (PT-Cy) is increasingly used in patients lacking HLA-matched sibling donors (MSD). We compared outcomes after Haplo-HCT using PT-Cy with MSD-HCT in patients with lymphoma, using the Center for International Blood and Marrow Transplant Research registry. MATERIALS AND METHODS: We evaluated 987 adult patients undergoing either Haplo-HCT (n = 180) or MSD-HCT (n = 807) following reduced-intensity conditioning regimens. The haploidentical group received graft-versus-host disease (GVHD) prophylaxis with PT-Cy with or without a calcineurin inhibitor and mycophenolate. The MSD group received calcineurin inhibitor-based GVHD prophylaxis. RESULTS: Median follow-up of survivors was 3 years. The 28-day neutrophil recovery was similar in the two groups (95% v 97%; P = .31). The 28-day platelet recovery was delayed in the haploidentical group compared with the MSD group (63% v 91%; P = .001). Cumulative incidence of grade II to IV acute GVHD at day 100 was similar between the two groups (27% v 25%; P = .84). Cumulative incidence of chronic GVHD at 1 year was significantly lower after Haplo-HCT (12% v 45%; P < .001), and this benefit was confirmed on multivariate analysis (relative risk, 0.21; 95% CI, 0.14 to 0.31; P < .001). For Haplo-HCT v MSD-HCT, 3-year rates of nonrelapse mortality (15% v 13%; P = .41), relapse/progression (37% v 40%; P = .51), progression-free survival (48% v 48%; P = .96), and overall survival (61% v 62%; P = .82) were similar. Multivariate analysis showed no significant difference between Haplo-HCT and MSD-HCT in terms of nonrelapse mortality (P = .06), progression/relapse (P = .10), progression-free survival (P = .83), and overall survival (P = .34). CONCLUSION: Haplo-HCT with PT-Cy provides survival outcomes comparable to MSD-HCT, with a significantly lower risk of chronic GVHD.
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