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

Abraham S. Kanate, Alberto Mussetti, Mohamed A. Kharfan-Dabaja, Kwang W. Ahn, Alyssa Digilio, Amer Beitinjaneh, Saurabh Chhabra, Timothy S. Fenske, Cesar Freytes, Robert Peter Gale, Siddhartha Ganguly, Mark Hertzberg, Evgeny Klyuchnikov, Hillard M. Lazarus, Richard Olsson, Miguel Angel Perales, Andrew Rezvani, Marcie Riches, Ayman Saad, Shimon SlavinSonali M. Smith, Anna Sureda, Jean Yared, Stefan Ciurea, Philippe Armand, Rachel Salit, Javier Bolaños-Meade, Mehdi Hamadani

Research output: Contribution to journalArticle

Abstract

We evaluated 917 adult lymphoma patients who received haploidentical (n 5 185) or HLAmatched unrelated donor (URD) transplantation either with (n 5 241) or without antithymocyte globulin (ATG; n 5 491) following reduced-intensity conditioning regimens. Haploidentical recipients received posttransplant cyclophosphamide-based graft-versushost disease (GVHD) prophylaxis, whereas URD recipients received calcineurin inhibitorbased 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 5 .44). Corresponding 1-year rates of chronic GVHD on univariate analysis were 13%, 51%, and 33%, respectively (P < .001).Onmultivariate analysis, grade III-IV acuteGVHDwas higher in URD without ATG (P 5 .001), as well as URD with ATG (P 5 .01), relative to haploidentical transplants. Similarly, relative to haploidentical transplants, risk of chronic GVHD was higher in URDwithout ATGandURD withATG(P < .0001). Cumulative incidence of relapse/ progression at 3 years was 36%, 28%, and 36%in the haploidentical,URDwithout ATG, and URD with ATG groups, respectively (P 5 .07). Corresponding 3-year overall survival (OS) was 60%, 62%, and 50% in the 3 groups, respectively, withmultivariate analysis showing no survival difference between URD without ATG (P 5 .21) or URD with ATG (P 5 .16), relative to haploidentical transplants.Multivariate analysis showed no difference between the 3 groups in terms of nonrelapsemortality (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. (Blood. 2016;127(7):938-947).

Original languageEnglish (US)
Pages (from-to)938-947
Number of pages10
JournalBlood
Volume127
Issue number7
DOIs
StatePublished - Feb 18 2016

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ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

Cite this

Kanate, A. S., Mussetti, A., Kharfan-Dabaja, M. A., Ahn, K. W., Digilio, A., Beitinjaneh, A., Chhabra, S., Fenske, T. S., Freytes, C., Gale, R. P., Ganguly, S., Hertzberg, M., Klyuchnikov, E., Lazarus, H. M., Olsson, R., Perales, M. A., Rezvani, A., Riches, M., Saad, A., ... Hamadani, M. (2016). Reduced-intensity transplantation for lymphomas using haploidentical related donors vs HLA-matched unrelated donors. Blood, 127(7), 938-947. https://doi.org/10.1182/blood-2015-09-671834