Haploidentical peripheral blood hematopoietic cell transplantation has become the preferred alternative donor transplant program in most centers in India, owing to its logistic and cost advantages. This is a retrospective analysis of 59 patients with high‐risk hematological malignancies who underwent haploidentical transplant in three different centers, using myeloablative conditioning and unmanipulated stem cell graft. GVHD prophylaxis was post‐transplant Cyclophosphamide (PTCy D + 3, D + 4) along with Tacrolimus and Mycophenolate Mofetil (D + 5 onwards). The median CD34 cell dose was 5.8 x 106 cells/kg. Neutrophils engrafted in 50 (83%) patients [median time D + 16 (range: 12‐38)] and platelets engrafted in 42 patients (70%) [median time D + 17 (range: 12‐50)]. Acute GVHD developed in 25 (41.7%) patients [Gr III/IV in 9] and Chronic GVHD in 15 (38.5%). 100‐day mortality was 33.8%. With a median follow‐up duration of 6.2 months (range: 0.4‐50.8 months), the relapse rate, treatment‐related mortality (TRM), and estimated 4‐year overall survival are 10.0%, 43.3%, and 38.0%, respectively. For the 31 deaths: causes included engraftment failure (n = 7), GVHD (n = 7), persistent disease (n = 1), relapsed disease (n = 5), bacterial sepsis (n = 5), viral pneumonia (n = 1), infection (n = 3), secondary graft failure (n = 2). TRM outcomes have reduced over time with experience. Myeloablative conditioning and haploidentical transplantation by a post‐transplant cyclophosphamide approach is feasible in a resource‐constrained setting, despite higher rates of GVHD and infection‐related mortality.

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Median age was 23 years (range, 15-63). Acute leukemia (13 lymphoblastic, 5 myeloblastic), followed by HodgkinÕs lymphoma (5), non-HodgkinÕs lymphoma (4), and chronic myeloid leukemia were the most common indication. Median PBSC CD34+ cells/kg was 7x10 6 (2-16). Neutrophil engraftment was achieved at a median of 16 days (range, 11-23), with platelet recovery at 16 days (range, 13-100). Seven patients (19%) were followed in a fully outpatient basis while the other 29 (81%) required hospitalization. Median length of stay (LOS) was 10 days (0-35). Seven patients (19%) stayed 2 7 days in hospital, while 22 patients >7 days. Febrile neutropenia was the most common reason for hospitalization (65.5%) and median day of admission was day +3 (1-14). The development of febrile neutropenia (P = .004) and a slower neutrophil engraftment (P = .023) were associated with the need for hospitalization. Eight of the 18 patients admitted for febrile neutropenia had a rapid response and no source of infection evidenced, thus LOS was 2 10 days. Age, mucositis, and acute GVHD were not associated with hospitalization need. The 2-year overall survival was 50% for patients with ambulatory transplant vs. 28% for those requiring hospitalization (log rank P = .08). Conclusion: Currently conventional transplantation is unaffordable for the majority of patients living in the developing world. Almost 20% of our patients did not require hospital admission. Although 62% of the patients were admitted, most of them had a short LOS. Our outpatient haploidentical HSCT program is feasible, potentially resulting in cost savings and perhaps a higher quality of life.