Haploidentical transplantation using posttransplant cyclophosphamide as GVHD prophylaxis in patients over age 70

Research output: Contribution to journalArticle

Abstract

Hematologic malignancies in older people are unlikely to be cured with chemotherapy alone. Advances in allogeneic blood or marrow transplantation (alloBMT), especially nonmyeloablative (NMA) conditioning and the use of haploidentical donors, now make this therapy available to older people; however, long-term outcomes and predictors of success are unclear. We reviewed the outcomes of 93 consecutive patients aged 70 and older (median, 72; range, 70-78), who underwent haploidentical BMT at Johns Hopkins Hospital between 1 September 2009 and 1 April 2018. All patients received NMA conditioning and posttransplantation cyclophosphamide (PTCy) as graft-versus-host disease (GVHD) prophylaxis. The 2-year overall survival was 53%, and 2-year event-free survival was 43%. The 180-day cumulative incidence (CuI) of nonrelapse mortality (NRM) was 14%, and the 2-year CuI was 27%. The 2-year CuI of relapse was 30%. Of 78 patients who were alive and had their weight recorded on day 180, weight loss predicted subsequent NRM (subdistribution hazard ratio, 1.0; 95% CI, 1-1.13; P 5 .048). In conclusion, haploidentical BMT with PTCy is feasible and relatively safe in septuagenarians. Although early, 6-month NRM was relatively low at 14%, but overall NRM continued to climb to 27% at 2 years, at least in part because of late deaths that appeared to be somewhat age related. Further studies to elucidate predictors of NRM are warranted.

Original languageEnglish (US)
Pages (from-to)2608-2616
Number of pages9
JournalBlood Advances
Volume3
Issue number17
DOIs
StatePublished - Sep 10 2019

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Graft vs Host Disease
Cyclophosphamide
Transplantation
Mortality
Incidence
Hematologic Neoplasms
Disease-Free Survival
Weight Loss
Bone Marrow
Tissue Donors
Weights and Measures
Recurrence
Drug Therapy
Survival

ASJC Scopus subject areas

  • Medicine(all)

Cite this

@article{8c72626ebc614471871f3b60ac6288e1,
title = "Haploidentical transplantation using posttransplant cyclophosphamide as GVHD prophylaxis in patients over age 70",
abstract = "Hematologic malignancies in older people are unlikely to be cured with chemotherapy alone. Advances in allogeneic blood or marrow transplantation (alloBMT), especially nonmyeloablative (NMA) conditioning and the use of haploidentical donors, now make this therapy available to older people; however, long-term outcomes and predictors of success are unclear. We reviewed the outcomes of 93 consecutive patients aged 70 and older (median, 72; range, 70-78), who underwent haploidentical BMT at Johns Hopkins Hospital between 1 September 2009 and 1 April 2018. All patients received NMA conditioning and posttransplantation cyclophosphamide (PTCy) as graft-versus-host disease (GVHD) prophylaxis. The 2-year overall survival was 53{\%}, and 2-year event-free survival was 43{\%}. The 180-day cumulative incidence (CuI) of nonrelapse mortality (NRM) was 14{\%}, and the 2-year CuI was 27{\%}. The 2-year CuI of relapse was 30{\%}. Of 78 patients who were alive and had their weight recorded on day 180, weight loss predicted subsequent NRM (subdistribution hazard ratio, 1.0; 95{\%} CI, 1-1.13; P 5 .048). In conclusion, haploidentical BMT with PTCy is feasible and relatively safe in septuagenarians. Although early, 6-month NRM was relatively low at 14{\%}, but overall NRM continued to climb to 27{\%} at 2 years, at least in part because of late deaths that appeared to be somewhat age related. Further studies to elucidate predictors of NRM are warranted.",
author = "Philip Imus and Tsai, {Hua Ling} and Leo Luznik and Fuchs, {Ephraim J} and Huff, {Carol Ann} and Douglas Gladstone and Patrick Lowery and Ambinder, {Richard F} and Borrello, {Ivan M} and Lode Swinnen and Nina Wagner-Johnston and Christian Gocke and {Abbas Ali}, Syed and Bola{\~n}os-Meade, {F. Javier} and Ravi Varadhan and Jones, {Richard J}",
year = "2019",
month = "9",
day = "10",
doi = "10.1182/bloodadvances.2019000155",
language = "English (US)",
volume = "3",
pages = "2608--2616",
journal = "Blood advances",
issn = "2473-9529",
publisher = "American Society of Hematology",
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TY - JOUR

T1 - Haploidentical transplantation using posttransplant cyclophosphamide as GVHD prophylaxis in patients over age 70

AU - Imus, Philip

AU - Tsai, Hua Ling

AU - Luznik, Leo

AU - Fuchs, Ephraim J

AU - Huff, Carol Ann

AU - Gladstone, Douglas

AU - Lowery, Patrick

AU - Ambinder, Richard F

AU - Borrello, Ivan M

AU - Swinnen, Lode

AU - Wagner-Johnston, Nina

AU - Gocke, Christian

AU - Abbas Ali, Syed

AU - Bolaños-Meade, F. Javier

AU - Varadhan, Ravi

AU - Jones, Richard J

PY - 2019/9/10

Y1 - 2019/9/10

N2 - Hematologic malignancies in older people are unlikely to be cured with chemotherapy alone. Advances in allogeneic blood or marrow transplantation (alloBMT), especially nonmyeloablative (NMA) conditioning and the use of haploidentical donors, now make this therapy available to older people; however, long-term outcomes and predictors of success are unclear. We reviewed the outcomes of 93 consecutive patients aged 70 and older (median, 72; range, 70-78), who underwent haploidentical BMT at Johns Hopkins Hospital between 1 September 2009 and 1 April 2018. All patients received NMA conditioning and posttransplantation cyclophosphamide (PTCy) as graft-versus-host disease (GVHD) prophylaxis. The 2-year overall survival was 53%, and 2-year event-free survival was 43%. The 180-day cumulative incidence (CuI) of nonrelapse mortality (NRM) was 14%, and the 2-year CuI was 27%. The 2-year CuI of relapse was 30%. Of 78 patients who were alive and had their weight recorded on day 180, weight loss predicted subsequent NRM (subdistribution hazard ratio, 1.0; 95% CI, 1-1.13; P 5 .048). In conclusion, haploidentical BMT with PTCy is feasible and relatively safe in septuagenarians. Although early, 6-month NRM was relatively low at 14%, but overall NRM continued to climb to 27% at 2 years, at least in part because of late deaths that appeared to be somewhat age related. Further studies to elucidate predictors of NRM are warranted.

AB - Hematologic malignancies in older people are unlikely to be cured with chemotherapy alone. Advances in allogeneic blood or marrow transplantation (alloBMT), especially nonmyeloablative (NMA) conditioning and the use of haploidentical donors, now make this therapy available to older people; however, long-term outcomes and predictors of success are unclear. We reviewed the outcomes of 93 consecutive patients aged 70 and older (median, 72; range, 70-78), who underwent haploidentical BMT at Johns Hopkins Hospital between 1 September 2009 and 1 April 2018. All patients received NMA conditioning and posttransplantation cyclophosphamide (PTCy) as graft-versus-host disease (GVHD) prophylaxis. The 2-year overall survival was 53%, and 2-year event-free survival was 43%. The 180-day cumulative incidence (CuI) of nonrelapse mortality (NRM) was 14%, and the 2-year CuI was 27%. The 2-year CuI of relapse was 30%. Of 78 patients who were alive and had their weight recorded on day 180, weight loss predicted subsequent NRM (subdistribution hazard ratio, 1.0; 95% CI, 1-1.13; P 5 .048). In conclusion, haploidentical BMT with PTCy is feasible and relatively safe in septuagenarians. Although early, 6-month NRM was relatively low at 14%, but overall NRM continued to climb to 27% at 2 years, at least in part because of late deaths that appeared to be somewhat age related. Further studies to elucidate predictors of NRM are warranted.

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U2 - 10.1182/bloodadvances.2019000155

DO - 10.1182/bloodadvances.2019000155

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VL - 3

SP - 2608

EP - 2616

JO - Blood advances

JF - Blood advances

SN - 2473-9529

IS - 17

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