Reduced-intensity transplantation for lymphomas using haploidentical related donors vs HLA-matched unrelated donors

Abraham S. Kanate(West Virginia University), Alberto Mussetti(Fondazione IRCCS Istituto Nazionale dei Tumori), Mohamed A. Kharfan‐Dabaja(Moffitt Cancer Center), Kwang Woo Ahn(Medical College of Wisconsin), Alyssa DiGilio, Amer Beitinjaneh, Saurabh Chhabra(Medical University of South Carolina), Timothy S. Fenske(Froedtert Hospital), César O. Freytes(The University of Texas at San Antonio Health Science Center), Robert Peter Gale(Imperial College London), Siddhartha Ganguly(University of Kansas Medical Center), Mark Hertzberg(Prince of Wales Hospital), Evgeny Klyuchnikov(University Cancer Center Hamburg), Hillard M. Lazarus(University Hospitals Cleveland Medical Center), Richard F. Olsson(Uppsala University), Miguel‐Angel Perales(Memorial Sloan Kettering Cancer Center), Andrew R. Rezvani(Stanford Blood Center), Marcie Riches(University of North Carolina at Chapel Hill), Ayman Saad(University of Alabama at Birmingham), Shimon Slavin, Sonali M. Smith(University of Chicago), Anna Sureda(Institut Català d'Oncologia), Jean A. Yared(University of Maryland, Baltimore), Stefan O. Ciurea(The University of Texas MD Anderson Cancer Center), Philippe Armand(Dana-Farber Cancer Institute), Rachel B. Salit(Fred Hutch Cancer Center), Javier Bolaños‐Meade(Johns Hopkins University), Mehdi Hamadani
Blood
December 16, 2015
10.1182/blood-2015-09-671834
Cited by 271Open Access
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Abstract

We evaluated 917 adult lymphoma patients who received haploidentical (n = 185) or HLA-matched unrelated donor (URD) transplantation either with (n = 241) or without antithymocyte globulin (ATG; n = 491) following reduced-intensity conditioning regimens. Haploidentical recipients received posttransplant cyclophosphamide-based graft-versus-host disease (GVHD) prophylaxis, whereas URD recipients received calcineurin inhibitor-based prophylaxis. Median follow-up of survivors was 3 years. The 100-day cumulative incidence of grade III-IV acute GVHD on univariate analysis was 8%, 12%, and 17% in the haploidentical, URD without ATG, and URD with ATG groups, respectively (P = .44). Corresponding 1-year rates of chronic GVHD on univariate analysis were 13%, 51%, and 33%, respectively (P < .001). On multivariate analysis, grade III-IV acute GVHD was higher in URD without ATG (P = .001), as well as URD with ATG (P = .01), relative to haploidentical transplants. Similarly, relative to haploidentical transplants, risk of chronic GVHD was higher in URD without ATG and URD with ATG (P < .0001). Cumulative incidence of relapse/progression at 3 years was 36%, 28%, and 36% in the haploidentical, URD without ATG, and URD with ATG groups, respectively (P = .07). Corresponding 3-year overall survival (OS) was 60%, 62%, and 50% in the 3 groups, respectively, with multivariate analysis showing no survival difference between URD without ATG (P = .21) or URD with ATG (P = .16), relative to haploidentical transplants. Multivariate analysis showed no difference between the 3 groups in terms of nonrelapse mortality (NRM), relapse/progression, and progression-free survival (PFS). These data suggest that reduced-intensity conditioning haploidentical transplantation with posttransplant cyclophosphamide does not compromise early survival outcomes compared with matched URD transplantation, and is associated with significantly reduced risk of chronic GVHD.

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