Reduced-Intensity Transplantation for Lymphomas Using Haploidentical Related Donors Versus HLA-Matched Sibling Donors: A Center for International Blood and Marrow Transplant Research Analysis

• Authors: Nilanjan Ghosh, Carolinas Healthcare System; Reem Karmali, Rush University; Vanderson Rocha, Churchill Hospital; Kwang Woo Ahn, Medical College of Wisconsin; Alyssa DiGilio, Medical College of Wisconsin; Parameswaran N. Hari, Medical College of Wisconsin; Veronika Bachanova, University of Minnesota; Ulrike Bacher, University Medicine Goettingen; Parastoo Dahi, Memorial Sloan Kettering Cancer Center; Marcos de Lima, University Hospitals Case Medical Center; Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital; Siddhartha Ganguly, University of Kansas; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute; Tim D. Prestidge, Starship Children’s Hospital; Bipin N. Savani, Vanderbilt University; Sonali M. Smith, University of Chicago; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran; Edmund Waller, Emory University; Samantha Jaglowski, he Ohio State University Medical Center; Alex F. Herrera, City of Hope National Medical Center; Philippe Armand, Dana-Farber Cancer Institute; Rachel B. Salit, Fred Hutchinson Cancer Research Center; Nina D. Wagner-Johnston, Johns Hopkins University; Ephraim Fuchs, Johns Hopkins University; Javier Bolanos-Meade, Johns Hopkins University; Mehdi Hamadani, Medical College of Wisconsin
• Journal Title: Journal of Clinical Oncology
• Volume: Volume 34, Number 26
• Publisher: American Society of Clinical Oncology | 2016-09-10, Pages 3141-3149
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1200/JCO.2015.66.3476
• Subjects: Health Sciences, Oncology; Health Sciences, General
• Keywords: Science & Technology; Life Sciences & Biomedicine; Oncology; STEM-CELL TRANSPLANTATION; UMBILICAL-CORD BLOOD; DOSE POSTTRANSPLANTATION CYCLOPHOSPHAMIDE; DISEASE RISK INDEX; BONE-MARROW; UNRELATED DONORS; IDENTICAL SIBLINGS; ALLOGENEIC TRANSPLANTATION; HODGKINS-LYMPHOMA; PERIPHERAL-BLOOD

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.