Reduced-intensity transplantation for lymphomas using haploidentical related donors versus HLA-matched sibling donors: A center for international blood and marrow transplant research analysis

Nilanjan Ghosh, Reem Karmali, Vanderson Rocha, Kwang Woo Ahn, Alyssa DiGilio, Parameswaran N. Hari, Veronika Bachanova, Ulrike Bacher, Parastoo Dahi, Marcos De Lima, Anita D'Souza, Timothy S. Fenske, Siddhartha Ganguly, Mohamed A. Kharfan-Dabaja, Tim D. Prestidge, Bipin N. Savani, Sonali M. Smith, Anna M. Sureda, Edmund K. Waller, Samantha JaglowskiAlex F. Herrera, Philippe Armand, Rachel B. Salit, Nina D. Wagner-Johnston, Ephraim Fuchs, Javier Bolaños-Meade, Mehdi Hamadani

Research output: Contribution to journalArticle

Abstract

Purpose: Related donor haploidentical hematopoietic cell transplantation (Haplo-HCT) using post-transplantation cyclophosphamide (PT-Cy) is increasingly used in patients lacking HLA-matched sibling donors (MSD). We compared outcomes after Haplo-HCT using PT-Cy with MSD-HCT in patients with lymphoma, using the Center for International Blood and Marrow Transplant Research registry. Materials and Methods: We evaluated 987 adult patients undergoing either Haplo-HCT (n = 180) or MSD-HCT (n = 807) following reduced-intensity conditioning regimens. The haploidentical group received graft-versushost disease (GVHD) prophylaxis with PT-Cy with or without a calcineurin inhibitor and mycophenolate. The MSD group received calcineurin inhibitor-based GVHD prophylaxis. Results: Median follow-up of survivors was 3 years. The 28-day neutrophil recovery was similar in the two groups (95% v 97%; P = .31). The 28-day platelet recovery was delayed in the haploidentical group compared with the MSD group (63% v 91%; P = .001). Cumulative incidence of grade II to IV acute GVHD at day 100 was similar between the two groups (27% v 25%; P = .84). Cumulative incidence of chronic GVHD at 1 year was significantly lower after Haplo-HCT (12% v 45%; P < .001), and this benefit was confirmed on multivariate analysis (relative risk, 0.21; 95% CI, 0.14 to 0.31; P < .001). For Haplo-HCT v MSD-HCT, 3-year rates of nonrelapse mortality (15% v 13%; P = .41), relapse/progression (37% v 40%; P = .51), progression-free survival (48% v 48%; P = .96), and overall survival (61% v 62%; P = .82) were similar. Multivariate analysis showed no significant difference between Haplo-HCT and MSD-HCT in terms of nonrelapse mortality (P = .06), progression/relapse (P = .10), progression-free survival (P = .83), and overall survival (P = .34). Conclusion: Haplo-HCT with PT-Cy provides survival outcomes comparable to MSD-HCT, with a significantly lower risk of chronic GVHD.

Original languageEnglish (US)
Pages (from-to)3141-3149
Number of pages9
JournalJournal of Clinical Oncology
Volume34
Issue number26
DOIs
StatePublished - Sep 10 2016

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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    Ghosh, N., Karmali, R., Rocha, V., Ahn, K. W., DiGilio, A., Hari, P. N., Bachanova, V., Bacher, U., Dahi, P., De Lima, M., D'Souza, A., Fenske, T. S., Ganguly, S., Kharfan-Dabaja, M. A., Prestidge, T. D., Savani, B. N., Smith, S. M., Sureda, A. M., Waller, E. K., ... Hamadani, M. (2016). Reduced-intensity transplantation for lymphomas using haploidentical related donors versus HLA-matched sibling donors: A center for international blood and marrow transplant research analysis. Journal of Clinical Oncology, 34(26), 3141-3149. https://doi.org/10.1200/JCO.2015.66.3476