Real‐world experience: Introduction of T cell replete haploidentical transplantations in a single center

Abstract

Objectives The aim of this study was to describe real‐world data on outcomes of T cell replete haploidentical hematopoietic stem cell transplantation (HSCT) after the introduction of this modality in a single center and to compare them with different donor types. Method Outcomes of 30 consecutive patients with hematological malignancies that received T cell replete haploidentical HSCT with posttransplantation cyclophosphamide (PTCY) from 2016 to 2018 in our center were analyzed and compared to the outcome of human leukocyte antigen (HLA)‐related and unrelated matched donor HSCT (n = 97) and to a historical cohort of T cell depleted haploidentical HSCT (n = 11). Results One year graft‐versus‐host‐free, relapse‐free survival in haploidentical HSCT was comparable with other donor types (haplo 40%, matched related donor [MRD] 33%, matched unrelated donor [MUD] 25%, p = 0.55). Non relapse mortality was high in haploidentical HSCT (50%), mostly due to infectious complications. However, relapse rates were only 3%, and OS and progression‐free survival after 1 year were 47% and thereby also similar to HLA‐matched HSCT in our center (MRD 53%, MUD 48%). Conclusion Our data show that T cell replete haploidentical HSCT has similar outcomes to HLA identical HSCT after introduction in our center. More strict adaptation on infection prevention was a crucial aspect of our learning curve. Overall, this type of transplantation is a feasible option when lacking an HLA‐identical donor. This option has advantages over an unrelated donor as it brings less logistical challenges than MUD transplantations.

Post-Transplant Cyclophosphamide versus Anti-Thymocyte Globulin in Patients with Hematological Malignancies Treated with Allogeneic Hematopoietic Stem Cell Transplantation from Haploidentical and Matched Unrelated Donors: A Real-Life Experience

“…Because of these encouraging results in haploidentical HSCT, PTCY has also been employed in HSCT with MRD, MUD, and mismatched unrelated donors. Currently, PTCY is used in combination with other immunosuppressive agents, such as cyclosporine A and mofetil mycophenolate, for GvHD prophylaxis in haploidentical and MUD HSCT [ 17 , 18 , 19 , 20 , 21 , 22 ]. In patients with ALL treated with MUD HSCT, cumulative incidence of acute and chronic GVHD is similar between PTCY- and ATG-prophylaxed patients, as also confirmed in our study.…”