Risk-stratified outcomes of nonmyeloablative HLA-haploidentical BMT with high-dose posttransplantation cyclophosphamide

Shannon R. McCurdy, Jennifer A. Kanakry, Margaret M. Showel, Hua Ling Tsai, Javier Bolaños-Meade, Gary L. Rosner, Christopher G. Kanakry, Karlo Perica, Heather J. Symons, Robert A. Brodsky, Douglas E. Gladstone, Carol Ann Huff, Keith W. Pratz, Gabrielle T. Prince, Amy E. Dezern, Ivana Gojo, William H. Matsui, Ivan Borrello, Michael A. McDevitt, Lode J. SwinnenB. Douglas Smith, Mark J. Levis, Richard F. Ambinder, Leo Luznik, Richard J. Jones, Ephraim J. Fuchs, Yvette L. Kasamon

Research output: Contribution to journalArticle

Abstract

Related HLA-haploidentical blood or marrow transplantation (BMT) with high-dose posttransplantation cyclophosphamide (PTCy) is being increasingly used because of its acceptable safety profile. To better define outcomes of nonmyeloablative (NMA) HLA-haploidentical BMT with PTCy, 372 consecutive adult hematologic malignancy patients who underwent this procedure were retrospectively studied. Risk-stratified outcomes were evaluated using the refined Disease Risk Index (DRI), developed to stratify disease risk across histologies and allogeneic BMT regimens. Patients received uniform conditioning, T-cell-replete allografting, then PTCy, mycophenolate mofetil, and tacrolimus. Six-month probabilities of nonrelapse mortality and severe acute graft-versus-host disease were 8% and 4%. With 4.1-year median follow-up, 3-year probabilities of relapse, progression-free survival (PFS), and overall survival (OS) were 46%, 40%, and 50%, respectively. By refined DRI group, low (n = 71), intermediate (n = 241), and high/very high (n = 60) risk groups had 3-year PFS estimates of 65%, 37%, and 22% (P < .0001), with corresponding 3-year OS estimates of 71%, 48%, and 35% (P = .0001). On multivariable analyses, the DRI was statistically significantly associated with relapse, PFS, and OS (each P < .001). This analysis demonstrates that the DRI effectively risk stratifies recipients of NMA HLA-haploidentical BMT with PTCy and also suggests that this transplantation platform yields similar survivals to those seen with HLA-matched BMT.

Original languageEnglish (US)
Pages (from-to)3024-3031
Number of pages8
JournalBlood
Volume125
Issue number19
DOIs
StatePublished - May 7 2015

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

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