The availability of cord blood (CB) and haploidentical (haplo) donors in all patient populations is not established. We have investigated the addition of haplo-CD34 cells to CB grafts (haplo-CBT) to speed myeloid engraftment. Thus, we have prospectively assessed CB and haplo donor availability in adult patients without 8/8 HLA-allele matched unrelated donors (URDs). Analysis of 89 patients eligible for haplo-CBT revealed 4 distinct patient groups. First, 6 patients (7% of total, 33% non-European) underwent CBT only as they had no suitable family members to type. In group 2, 49 patients (45% non-European) received haplo-CBT using the first haplo donor chosen. Group 3 (n = 21, 76% non-European) underwent CBT with/without haplo. In this group, the first haplo donor chosen failed clearance in 20 patients and transplantation was too urgent to permit donor evaluation in 1. Fifty-three haplo donors were evaluated (2 to 6 per patient) for 21 group 3 patients, and 43 of 53 (81%) haplos failed clearance for predominantly medical and/or psychosocial reasons. Group 4, (n = 13, 85% non-European with a high median weight of 96 kilograms) had no CB grafts with/without no haplo donors. Overall, African patients had the worst donor availability with only 65% having a suitable CB graft and only 44% having a suitable haplo donor. Additionally, in non-European patients, a greater number of haplos required evaluation/patient to secure a suitable haplo graft. Although these data should be confirmed in a larger study, it suggests that there are barriers to the availability of both CB and haplo grafts in adult patients without 8/8 URDs, especially in those with African ancestry, and has multiple practical implications for patient management.
peer, unblinded review. The rates of HAHO-CDI decreased from a cumulative of 73 per 10.000 patient-days to a rate of 23.8 per 10.000 patient-days, with no new cases during the last month of surveillance. Conclusion: A multidisciplinary approach to decrease rates of CDI including: education, enhanced environmental cleaning with review and feedback, and standard use of UVC pulsed technology was effective to reduce the rates of CDI in a bone marrow transplant unit.
Background: Many patients in need of hematopoietic allografts without matched siblings do not have any 8/8 HLA-matched unrelated volunteer donors (URD). This is especially true in patients of non-European & mixed ancestries & this applies to 50% of patients undergoing URD searches at our center. While unrelated donor CB & haploidentical (haplo) related donors offer alternative graft sources their availability in all patient populations is not established. Methods: We prospectively evaluated the availability of CB & haplo grafts 9/2012 - 7/2015 in a phase II clinical trial of double unit CBT (dCBT) supplemented by haplo CD34+ cells in patients with hematologic malignancies lacking an 8/8 HLA-matched URD. CB units required a cryopreserved TNC dose ≥ 1.5 x 107 /kg/unit, were ≥ 4/6 HLA-A,-B antigen, -DRB1 allele matched, & high resolution 8 HLA-allele match & CD34+ cell dose were also considered. Standard criteria were used to define donor eligibility for haplo PBSC collection. Reasons for failure of haplo donor clearance were classified as either medical ineligibility or psychosocial (including financial inability to relocate to our transplant center, international donors unable to come to the US, donor refusal or withdrawal of consent during workup, donor imprisonment, or patient refusal to approach the donor for collection). Results: 89 patients [median age 50 years (range 15-68)] were evaluated. Diagnoses included 58 acute leukemias, 10 MDS/ myeloproliferative disorders, & 21 NHL/ Hodgkins lymphomas. Evaluation of CB graft &/or haplo donor availability revealed 3 patient groups. Group 1 (59/89, 66% of the total) had both suitable CB grafts & haplo donors and underwent dCBT-haplo CD34+ transplants. 33% were non-European & their median weight was 78 kg (range 33-133). The CB grafts had a median infused TNC of 2.4 (larger unit) & 1.9 (smaller unit) x 107/kg with a median 5/8 (range 2-7/8) donor-recipient HLA-match whereas the 59 haplos (median age 36 years, range 15-71) included 17 siblings, 9 parents, 27 children, & 6 extended family. In Group 1, the first haplo chosen was cleared for donation in 52/59 (88%) patients whereas 6/59 (10%) required work-up of 2-4 haplos/ patient for a total of 16 donors who failed clearance for medical or psychosocial reasons. The remaining patient had pan-donor specific HLA antibodies to 5 haplos & subsequently a 7/8 HLA-matched nephew was secured. Group 2 (17/89, 19% of the total) received only dCB grafts due to failure to identify a suitable haplo donor. Group 2 patients were more likely to be non-European (65%) but had a similar weight (median 78 kg, range 55-118) as Group 1. The CB grafts were also similar to Group 1 (median infused TNC 2.2 & 1.5 x 107/kg & median donor-recipient HLA-match 5/8, range 3-8/8). Of these 17 dCBT only patients, 6 had no eligible haplos identified within their extended family whereas in 8 patients 1-4 haplos/ patient failed to clear for medical reasons, combinations of medical & psychosocial reasons, or pursuit of haplos failed due to a combination of medical failure & subsequent transplant urgency. Of the remaining patients, 2 had haplos who failed for purely psychosocial reasons, & in 1 the transplant was too urgent to delay to complete donor clearance. In this group a total of 19 haplos failed to clear. Finally, Group 3 (13/89, 15% of the total) had no dCB grafts + no haplo grafts. They were nearly all (85%) non-European including 7 patients of African ancestry & they had a higher weight (median 95 kg, range 52-143). One of these patients received a haplo transplant, 3 had no haplos identified, & in 9 patients clearance of potential haplos was not determined to date, or they pursued alternative therapy, were lost to follow-up, or their disease progressed. Conclusions: In this study, 15% of patients had no CB grafts & these patients were predominantly non-European with a high weight. Additionally, over 20% of patients had no haplo grafts & compromised haplo donor availability was common especially in minority patients. This data demonstrates that even in patients with identified haplos, donor clearance cannot be assumed & the need for workup of multiple haplos/ patient can delay admission & substantially add to transplant costs. These observations support continued investment in public CB inventories to provide a readily available graft especially for minority patients who are at increased risk for inability to identify a CB &/or haplo donor. Disclosures Perales: National Marrow Donor Program: Membership on an entity's Board of Directors or advisory committees; Merck: Honoraria; Amgen: Honoraria; Incyte: Honoraria; Seattle Genetics: Honoraria. Giralt:TAKEDA: Consultancy, Honoraria, Research Funding; JAZZ: Consultancy, Honoraria, Research Funding, Speakers Bureau; AMGEN: Consultancy, Research Funding; SANOFI: Consultancy, Honoraria, Research Funding; CELGENE: Consultancy, Honoraria, Research Funding. Scaradavou:National Cord Blood Program- New York Blood Center: Employment.
MRD and URD alloHCT. We aimed to compare outcomes after HRD alloHCT using PTCy to those after URD alloHCT in adults with hematologic malignancies. Method: We report outcomes of 59 patients who had alloHCT using URD (n¼48) or HRD (n¼11) for hematological malignancies between Jan 2012 and May 2015. Both groups received reduced intensity/non-myeloablativeconditioning and GVHD prophylaxis per institutional protocol (Table 1). Outcomes of interest were day 100 mortality, 1-year survival, incidence of Graft-versus-Host Disease (GVHD; acute and chronic), non-relapse mortality (NRM) Results: Median follow-up in the study was 12 months. Day 100 mortality was 18.2% (2/11) and 25% (12/48) in HRD and URD cohorts respectively. One-year survival was 63.6% (7/11) in HRD and 52.3% (22/42) in URD cohort. Median OS was 17.4 months and 10.9 months in HRD and URD cohorts. Incidence of Grade I-IV aGVHD and GIII-IV aGVHD was 27.3% and 9% in HRD and 68.7% and 27.1% in URD cohort. Three of 11 pts in HRD cohort and 13 of 48 pts in URD cohort were unevaluable for cGVHD due to maturing data, loss to follow up or death. However, 3 of 8 (37.5%) patients in HRD cohort and 29 of 35 (82.5%) in URD cohort developed cGVHD. Twelve of 29 patients (41.4%) in URD cohort and none in HRD cohort developed extensive cGVHD. In the URD cohort, 2 of 47 pts (4.2%) relapsed with a mean time to relapse of 10 months and 5 of 11 (45.4%) in HRD cohort relapsed with a mean time to
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