| Literature DB >> 32434056 |
Annie Im1, Armin Rashidi2, Tao Wang3, Michael Hemmer4, Margaret L MacMillan5, Joseph Pidala6, Madan Jagasia7, Steven Pavletic8, Navneet S Majhail9, Daniel Weisdorf2, Hisham Abdel-Azim10, Vaibhav Agrawal11, A Samer Al-Homsi12, Mahmoud Aljurf13, Medhat Askar14, Jeffery J Auletta15, Asad Bashey16, Amer Beitinjaneh17, Vijaya Raj Bhatt18, Michael Byrne7, Jean-Yves Cahn19, Mitchell Cairo20, Paul Castillo21, Jan Cerny22, Saurabh Chhabra4, Hannah Choe23, Stefan Ciurea24, Andrew Daly25, Miguel Angel Diaz Perez26, Nosha Farhadfar27, Shahinaz M Gadalla28, Robert Gale29, Siddhartha Ganguly30, Usama Gergis31, Rabi Hanna32, Peiman Hematti33, Roger Herzig34, Gerhard C Hildebrandt35, Deepesh P Lad36, Catherine Lee37, Leslie Lehmann38, Lazaros Lekakis17, Rammurti T Kamble39, Mohamed A Kharfan-Dabaja40, Pooja Khandelwal41, Rodrigo Martino42, Hemant S Murthy40, Taiga Nishihori43, Tracey A O'Brien44, Richard F Olsson45, Sagar S Patel46, Miguel-Angel Perales47, Tim Prestidge48, Muna Qayed49, Rizwan Romee50, Hélène Schoemans51, Sachiko Seo52, Akshay Sharma53, Melhem Solh54, Roger Strair55, Takanori Teshima56, Alvaro Urbano-Ispizua57, Marjolein Van der Poel58, Ravi Vij59, John L Wagner60, Basem William61, Baldeep Wirk62, Jean A Yared63, Steve R Spellman4, Mukta Arora2, Betty K Hamilton64.
Abstract
Post-transplant cyclophosphamide (PTCy) has significantly increased the successful use of haploidentical donors with a relatively low incidence of graft-versus-host disease (GVHD). Given its increasing use, we sought to determine risk factors for GVHD after haploidentical hematopoietic cell transplantation (haplo-HCT) using PTCy. Data from the Center for International Blood and Marrow Transplant Research on adult patients with acute myeloid leukemia, acute lymphoblastic leukemia, myelodysplastic syndrome, or chronic myeloid leukemia who underwent PTCy-based haplo-HCT (2013 to 2016) were analyzed and categorized into 4 groups based on myeloablative (MA) or reduced-intensity conditioning (RIC) and bone marrow (BM) or peripheral blood (PB) graft source. In total, 646 patients were identified (MA-BM = 79, MA-PB = 183, RIC-BM = 192, RIC-PB = 192). The incidence of grade 2 to 4 acute GVHD at 6 months was highest in MA-PB (44%), followed by RIC-PB (36%), MA-BM (36%), and RIC-BM (30%) (P = .002). The incidence of chronic GVHD at 1 year was 40%, 34%, 24%, and 20%, respectively (P < .001). In multivariable analysis, there was no impact of stem cell source or conditioning regimen on grade 2 to 4 acute GVHD; however, older donor age (30 to 49 versus <29 years) was significantly associated with higher rates of grade 2 to 4 acute GVHD (hazard ratio [HR], 1.53; 95% confidence interval [CI], 1.11 to 2.12; P = .01). In contrast, PB compared to BM as a stem cell source was a significant risk factor for the development of chronic GVHD (HR, 1.70; 95% CI, 1.11 to 2.62; P = .01) in the RIC setting. There were no differences in relapse or overall survival between groups. Donor age and graft source are risk factors for acute and chronic GVHD, respectively, after PTCy-based haplo-HCT. Our results indicate that in RIC haplo-HCT, the risk of chronic GVHD is higher with PB stem cells, without any difference in relapse or overall survival.Entities:
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Year: 2020 PMID： 32434056 PMCID： PMC7391266 DOI： 10.1016/j.bbmt.2020.05.001
Source DB: PubMed Journal: Biol Blood Marrow Transplant ISSN： 1083-8791 Impact factor: 5.742