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

Abstract

Related donor haploidentical hematopoietic cell transplantation (Haplo-HCT) using posttransplantation 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 MethodsWe 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. ResultsMedian 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). ConclusionHaplo-HCT with PT-Cy provides survival outcomes comparable to MSD-HCT, with a significantly lower risk of chronic GVHD.

T Cell-Replete Haploidentical Transplantation with Post-Transplantation Cyclophosphamide for Hodgkin Lymphoma Relapsed after Autologous Transplantation: Reduced Incidence of Relapse and of Chronic Graft-versus-Host Disease Compared with HLA-Identical Related Donors

“…Our findings are in line with a previous observation from the John Hopkins group that described a reduced cumulative incidence of relapse after Haplo-SCT compared with HLAid-SCT from an MRD or an MUD [25]. Our results are also in agreement with the recent retrospective studies reported by Kanate et al [26] and Ghosh et al [27], in which patients receiving a transplant from a haploidentical donor had a lower incidence of cGVHD compared with those receiving a transplant from an MUD. Even if a higher proportion of patients in the Haplo-SCT group received a BM graft compared with the HLAid-SCT group, the lower incidence of cGVHD after Haplo-SCT is more likely due to the use of PT-CY, as was also shown in a recent study from the European Group for Blood and Marrow Transplantation [28] that found no difference in terms of cGVHD incidence between BM and PBSCs as graft sources for Haplo-SCT.…”

T Cell-Replete Haploidentical Transplantation with Post-Transplantation Cyclophosphamide for Hodgkin Lymphoma Relapsed after Autologous Transplantation: Reduced Incidence of Relapse and of Chronic Graft-versus-Host Disease Compared with HLA-Identical Related Donors

“…Our findings are in line with a previous observation from the John Hopkins group that described a reduced cumulative incidence of relapse after Haplo-SCT compared with HLAid-SCT from an MRD or an MUD [25]. Our results are also in agreement with the recent retrospective studies reported by Kanate et al [26] and Ghosh et al [27], in which patients receiving a transplant from a haploidentical donor had a lower incidence of cGVHD compared with those receiving a transplant from an MUD. Even if a higher proportion of patients in the Haplo-SCT group received a BM graft compared with the HLAid-SCT group, the lower incidence of cGVHD after Haplo-SCT is more likely due to the use of PT-CY, as was also shown in a recent study from the European Group for Blood and Marrow Transplantation [28] that found no difference in terms of cGVHD incidence between BM and PBSCs as graft sources for Haplo-SCT.…”

Haploidentical transplantation has a superior graft-versus-leukemia effect than HLA-matched sibling transplantation for Ph– high-risk B-cell acute lymphoblastic leukemia

“…[6,46,47] A growing body of research has suggested that HID and MSD transplantation have similar incidence and mortality of GVHD. [9,13,36,48] In the present study, after ruling out the effects of DLI, the incidence of grade II-IV aGVHD was higher in the HID group, whereas the incidences of severe aGVHD and cGVHD were similar between the HID and MSD groups, which was consistent with our previous results. [9,1] However, the incidences of overall aGVHD and cGVHD did not differ between the two groups.…”

Allogeneic transplantation in elderly patients ≥65 years with non-Hodgkin lymphoma: a time-trend analysis

“…However, with the recent increased use of PTCy-based GVHD prophylaxis, it is possible that futures studies will demonstrate a decrease in chronic GVHD with further adaptation of this regimen. Our study found no survival difference among patients receiving PTCy GVHD prophylaxis supporting the use of this regimen in older patients with NHL, similar to previously published studies 22,23 . Last, it is notable that NRM, like acute GVHD, has not improved over the designated study period.…”

T Cell-Replete Haploidentical Transplantation with Post-Transplantation Cyclophosphamide for Hodgkin Lymphoma Relapsed after Autologous Transplantation: Reduced Incidence of Relapse and of Chronic Graft-versus-Host Disease Compared with HLA-Identical Related Donors

“…Our findings are in line with a previous observation from the John Hopkins group that described a reduced cumulative incidence of relapse after Haplo-SCT compared with HLAid-SCT from an MRD or an MUD [25]. Our results are also in agreement with the recent retrospective studies reported by Kanate et al [26] and Ghosh et al [27], in which patients receiving a transplant from a haploidentical donor had a lower incidence of cGVHD compared with those receiving a transplant from an MUD. Even if a higher proportion of patients in the Haplo-SCT group received a BM graft compared with the HLAid-SCT group, the lower incidence of cGVHD after Haplo-SCT is more likely due to the use of PT-CY, as was also shown in a recent study from the European Group for Blood and Marrow Transplantation [28] that found no difference in terms of cGVHD incidence between BM and PBSCs as graft sources for Haplo-SCT.…”

Haploidentical transplantation has a superior graft-versus-leukemia effect than HLA-matched sibling transplantation for Ph– high-risk B-cell acute lymphoblastic leukemia

“…[6,46,47] A growing body of research has suggested that HID and MSD transplantation have similar incidence and mortality of GVHD. [9,13,36,48] In the present study, after ruling out the effects of DLI, the incidence of grade II-IV aGVHD was higher in the HID group, whereas the incidences of severe aGVHD and cGVHD were similar between the HID and MSD groups, which was consistent with our previous results. [9,1] However, the incidences of overall aGVHD and cGVHD did not differ between the two groups.…”

Allogeneic transplantation in elderly patients ≥65 years with non-Hodgkin lymphoma: a time-trend analysis

“…However, with the recent increased use of PTCy-based GVHD prophylaxis, it is possible that futures studies will demonstrate a decrease in chronic GVHD with further adaptation of this regimen. Our study found no survival difference among patients receiving PTCy GVHD prophylaxis supporting the use of this regimen in older patients with NHL, similar to previously published studies 22,23 . Last, it is notable that NRM, like acute GVHD, has not improved over the designated study period.…”

T Cell-Replete Haploidentical Transplantation with Post-Transplantation Cyclophosphamide for Hodgkin Lymphoma Relapsed after Autologous Transplantation: Reduced Incidence of Relapse and of Chronic Graft-versus-Host Disease Compared with HLA-Identical Related Donors

“…Our findings are in line with a previous observation from the John Hopkins group that described a reduced cumulative incidence of relapse after Haplo-SCT compared with HLAid-SCT from an MRD or an MUD [25]. Our results are also in agreement with the recent retrospective studies reported by Kanate et al [26] and Ghosh et al [27], in which patients receiving a transplant from a haploidentical donor had a lower incidence of cGVHD compared with those receiving a transplant from an MUD. Even if a higher proportion of patients in the Haplo-SCT group received a BM graft compared with the HLAid-SCT group, the lower incidence of cGVHD after Haplo-SCT is more likely due to the use of PT-CY, as was also shown in a recent study from the European Group for Blood and Marrow Transplantation [28] that found no difference in terms of cGVHD incidence between BM and PBSCs as graft sources for Haplo-SCT.…”

Haploidentical transplantation has a superior graft-versus-leukemia effect than HLA-matched sibling transplantation for Ph– high-risk B-cell acute lymphoblastic leukemia

“…[6,46,47] A growing body of research has suggested that HID and MSD transplantation have similar incidence and mortality of GVHD. [9,13,36,48] In the present study, after ruling out the effects of DLI, the incidence of grade II-IV aGVHD was higher in the HID group, whereas the incidences of severe aGVHD and cGVHD were similar between the HID and MSD groups, which was consistent with our previous results. [9,1] However, the incidences of overall aGVHD and cGVHD did not differ between the two groups.…”

Allogeneic transplantation in elderly patients ≥65 years with non-Hodgkin lymphoma: a time-trend analysis

“…However, with the recent increased use of PTCy-based GVHD prophylaxis, it is possible that futures studies will demonstrate a decrease in chronic GVHD with further adaptation of this regimen. Our study found no survival difference among patients receiving PTCy GVHD prophylaxis supporting the use of this regimen in older patients with NHL, similar to previously published studies 22,23 . Last, it is notable that NRM, like acute GVHD, has not improved over the designated study period.…”