Haploidentical Stem Cell Transplantation With Posttransplant Cyclophosphamide Therapy vs Other Donor Transplantations in Adults With Hematologic Cancers

Gagelmann, Nico; Bacigalupo, Andrea; Rambaldi, Alessandro; Hoelzer, Dieter; Halter, Jörg; Sanz, Jaime; Bonifazi, Francesca; Meijer, Ellen; Itälä‐Remes, Maija; Marková, Markéta; Solano, Carlos; Kröger, Nicolaus

doi:10.1001/jamaoncol.2019.3541

Cited by 94 publications

(54 citation statements)

References 79 publications

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“…Interestingly, we observed a promising outcome in this subgroup of patients receiving a CB or haplo transplant. Survival was similar to matched unrelated donor and superior to mismatched unrelated donor; furthermore, lower rates of severe cGVHD were observed, consistent with recent publications 36 …”

Section: Discussionsupporting

confidence: 91%

Allogeneic stem cell transplant in patients with acute myeloid leukemia and karnofsky performance status score less than or equal to 80%: A study from the acute leukemia working party of the European Society for Blood and Marrow Transplantation (EBMT)

et al. 2020

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Limited data are currently available on the outcome of patients with acute myeloid leukemia (AML) undergoing allogeneic stem cell transplantation (allo‐SCT) with a reduced performance status. We herein present the results of a registry study on 2,936 AML patients undergoing allo‐SCT in first remission (CR1) with a Karnofsky Performance Status (KPS) score less than or equal to 80%. Two‐year leukemia‐free survival (LFS), overall survival (OS) and graft‐versus‐host disease (GVHD)‐free, and relapse‐free survival (GRFS) rates were 54%, 59%, and 41%, respectively. In multivariable analysis, patients with a KPS score = 80% had lower non‐relapse mortality (NRM) and superior OS in comparison to patients with a KPS score <80% (p < 0.001). In the subgroup of patients with a KPS score =80%, a reduced‐intensity conditioning (RIC) regimen was associated with an increased risk of relapse (p = 0.002) and lower GRFS (p < 0.001) compared to myeloablative conditioning (MAC). Differently, in patients with a KPS score <80%, a RIC regimen resulted in lower NRM (p < 0.001), whereas relapse incidence did not differ, thus leading to an improved GRFS (p = 0.008) as compared to MAC. A transplant from a matched sibling donor (MSD) was associated with a reduced incidence of grade III‐IV acute GVHD (p < 0.01) and NRM (p < 0.01) in comparison to other donor types. In conclusion, allo‐SCT appears feasible in AML patients with a jeopardized KPS score. Survival is significantly affected by the conditioning intensity, which should be adjusted according to the severity of KPS impairment.

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Section: Discussionsupporting

confidence: 91%

Allogeneic stem cell transplant in patients with acute myeloid leukemia and karnofsky performance status score less than or equal to 80%: A study from the acute leukemia working party of the European Society for Blood and Marrow Transplantation (EBMT)

et al. 2020

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“…They concluded that Haplo-SCT for hematologic malignancies achieved the same overall survival as MUD-SCT, with a lower incidence of GVHD and NRM, and advocated that Haplo-SCT with PTCy should strongly be considered as the first option for adult patients with hematologic malignancies who do not have matched sibling donors in experienced centers. Gagelmann et al [38] reported another meta-analysis comparing Haplo-SCT with other donors and found that Haplo-SCT was associated with similar all-cause mortality, better NRM outcomes, but increased relapse compared with MUD-SCT. In contrast, in our current meta-analysis, we demonstrated that Haplo-SCT had similar clinical outcomes compared to the MUD-SCT in terms of OS, PFS, NRM and RR, but was superior to MUD-SCT in terms of reduced aGVHD and cGVHD risk.…”

Section: Discussionmentioning

confidence: 99%

Haploidentical stem cell transplantation vs matched unrelated donor transplantation in adults with hematologic malignancies: a systematic review and meta-analysis

Han

Jiang

et al. 2020

Hematology

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Objectives: Haploidentical hematopoietic stem cell transplantation (Haplo-SCT) and matched unrelated donor transplantation (MUD-SCT) are two important options when a matched sibling donor (MSD) is unavailable. Several studies comparing Haplo-SCT and MUD-SCT have reported inconsistent clinical outcomes. Therefore, it is necessary to synthesize the existing evidence regarding outcomes of stem cell transplantations comparing Haplo-SCT with MUD-SCT. Methods: We searched for titles of articles in MEDLINE (PubMed), Cochrane library, EMBASE database that compared transplantation with Haplo-SCT versus MUD-SCT. To compare clinical outcomes between Haplo-SCT and MUD-SCT, we performed a meta-analysis of 17 studies and reported the pooled odd ratios (OR) of 6 endpoints including overall survival (OS), progression free survival (PFS), non-relapse mortality (NRM), relapse rate (RR), acute graft-versus-host disease (aGVHD) and chronic graft-versus-host disease (cGVHD). Results: We found that Haplo-SCT was associated with a comparable OS (pooled OR of 0.99, 95% Confidence Interval (CI) 0.86-1.14), PFS (OR 1.00, 95% CI 0.88-1.15), NRM (OR 0.83, 95% CI 0.65-1.04) and RR (OR 1.08, 95% CI 0.95-1.22) compared to MUD-SCT. We also found a significantly decreased risk of aGVHD (OR 0.74, 95% CI 0.62-0.88) and cGVHD (OR 0.50, 95% CI 0.38-0.66) in Haplo-SCT group. Conclusion: Results of this meta-analysis demonstrates that Haplo-SCT achieves comparable clinical outcomes compared to MUD-SCT in terms of OS, PFS, TRM and RR, but is better than MUD-SCT in terms of decreased aGVHD and cGVHD risk. Haplo-SCT is a valid option for patient needing urgent transplantation.

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“…Because fully matched donors may not be available, the use of haploidentical donors is currently being explored, especially since this technique improved significantly in the last 15 years with the introduction of post allo-HSCT cyclophosphamide as GVHD prophylaxis. In a meta-analysis of 30 studies on adults with hematological malignancies, haploidentical stem cell transplantation was associated with increased mortality compared with sibling donors, similar mortality compared with matched unrelated donors and reduced mortality compared with mismatched unrelated donors [ 43 ]. Further studies including haploidentical donors for allo-HSCT in CTCL are needed to define the place of haploidentical transplantation when neither sibling nor matched unrelated donors are available.…”

Section: Different Conditioning Approaches and Types Of Donorsmentioning

confidence: 99%

Allogeneic Hematopoietic Stem Cell Transplantation in Cutaneous T-Cell Lymphomas

Dumont

Latour

Ram‐Wolff

et al. 2020

Cancers

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Cutaneous T-cell lymphomas (CTCLs) are non-Hodgkin lymphomas that develop primarily in the skin. They account for almost 80% of primary cutaneous lymphomas. Epidermotropic CTCLs (mycosis fungoides (MF) and Sézary syndrome (SS)) are the most common form of CTCL. The course of the disease ranges from an indolent clinical behavior in early-stage disease to an aggressive evolution in the advanced stages. Advanced-stage disease is defined by the presence of tumors, erythroderma, or significant blood, nodal or visceral involvement. Advanced-stage disease is characterized by frequent disease relapses, refractory disease, a severely impaired quality of life and reduced overall survival. In the last twenty-five years, allogeneic hematopoietic stem cell transplantation (HSCT) has led to prolonged remissions in advanced CTCL, presumably linked to a graft-versus-lymphoma effect and is thus emerging as a potential cure of the disease. However, the high post-transplant relapse rate and severe morbidity and mortality associated with graft-versus-host disease and infections are important issues. Allogeneic HSCT is thus mostly considered in young patients with no comorbidities and an aggressive, advanced-stage CTCL. Allogeneic HSCT gives the best results in patients with a pre-transplant complete remission of the lymphoma. For this reason, one of the challenges is to define the best time to consider allogeneic HSCT in the disease course. Early identification of patients at high risk for progression is important to identify candidates who may benefit from allogeneic HSCT before their disease becomes treatment-refractory. This review describes the role of allogeneic HSCT in CTCL, summarizes the published data and future perspectives in this area.

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Haploidentical Stem Cell Transplantation With Posttransplant Cyclophosphamide Therapy vs Other Donor Transplantations in Adults With Hematologic Cancers

Cited by 94 publications

References 79 publications

Allogeneic stem cell transplant in patients with acute myeloid leukemia and karnofsky performance status score less than or equal to 80%: A study from the acute leukemia working party of the European Society for Blood and Marrow Transplantation (EBMT)

Allogeneic stem cell transplant in patients with acute myeloid leukemia and karnofsky performance status score less than or equal to 80%: A study from the acute leukemia working party of the European Society for Blood and Marrow Transplantation (EBMT)

Haploidentical stem cell transplantation vs matched unrelated donor transplantation in adults with hematologic malignancies: a systematic review and meta-analysis

Allogeneic Hematopoietic Stem Cell Transplantation in Cutaneous T-Cell Lymphomas

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