Comparable composite endpoints after HLA-matched and HLA-haploidentical transplantation with post-transplantation cyclophosphamide

Shannon R. McCurdy, Yvette L. Kasamon, Christopher G. Kanakry, Javier Bolaños-Meade, Hua Ling Tsai, Margaret M. Showel, Jennifer A. Kanakry, Heather J. Symons, Ivana Gojo, B. Douglas Smith, Maria P. Bettinotti, William H. Matsui, Amy E. Dezern, Carol Ann Huff, Ivan Borrello, Keith W. Pratz, Douglas E. Gladstone, Lode J. Swinnen, Robert A. Brodsky, Mark J. LevisRichard F. Ambinder, Ephraim J. Fuchs, Gary L. Rosner, Richard J. Jones, Leo Luznik

Research output: Contribution to journalArticlepeer-review

Abstract

Composite endpoints that not only encompass mortality and relapse, but other critical post-transplant events such as graft-versus- host disease, are being increasingly utilized to quantify survival without significant morbidity after allogeneic blood or marrow transplantation. High-dose, post-transplantation cyclophosphamide reduces severe graft-versus-host disease with allogeneic marrow transplantation, making composite endpoints after this management particularly interesting. We retrospectively analyzed 684 adults with hematologic malignancies who received T-cell-replete bone marrow grafts and cyclophosphamide after myeloablative HLA-matched related (n=192) or unrelated (n=120), or non-myeloablative HLA-haploidentical (n=372) donor transplantation. The median follow up was 4 (range, 0.02-11.4) years. Graft-versus-host disease-free, relapse-free survival was defined as the time after transplantation without grade III-IV acute graft-versus-host disease, chronic graft-versus-host disease requiring systemic treatment, relapse, or death. Chronic graft-versus-host disease-free, relapse-free survival was defined as the time after transplantation without moderate or severe chronic graft-versus-host disease, relapse, or death. One-year graftversus- host disease-free, relapse-free survival and chronic graft-versushost disease-free, relapse-free survival estimates were, respectively, 47% (95% CI: 41-55%) and 53% (95% CI: 46-61%) after myeloablative HLAmatched related, 42% (95% CI: 34-52%) and 52% (95% CI: 44-62%) after myeloablative HLA-matched unrelated, and 45% (95% CI: 40- 50%) and 50% (95% CI: 45-55%) after non-myeloablative HLA-haploidentical donor transplantation. In multivariable models, there were no differences in graft-versus-host disease-free, or chronic graft-versus-host disease-free, relapse-free survival after either myeloablative HLAmatched unrelated or non-myeloablative HLA-haploidentical, compared with myeloablative HLA-matched related donor transplantation. Although limited by inclusion of dissimilar cohorts, we found that posttransplantation cyclophosphamide-based platforms yield comparable composite endpoints across conditioning intensity, donor type, and HLA match.

Original languageEnglish (US)
Pages (from-to)391-400
Number of pages10
JournalHaematologica
Volume102
Issue number2
DOIs
StatePublished - 2017

ASJC Scopus subject areas

  • Hematology

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