PTCy-based haploidentical vs matched related or unrelated donor reduced-intensity conditioning transplant for DLBCL

Abstract

This study retrospectively compared long-term outcomes of nonmyeloablative/reduced intensity conditioning (NMC/RIC) allogeneic hematopoietic cell transplantation (allo-HCT) from a haploidentical family donor (haplo-HCT) using posttransplant cyclophosphamide (PTCy) with those of matched sibling donor (MSD) and matched unrelated donor (MUD) with or without T-cell depletion (TCD+/TCD−) in patients with relapsed diffuse large B-cell lymphoma (DLBCL). Adult patients with DLBCL who had undergone their first NMC/RIC allo-HCT between 2008 and 2015 were included. Recipients of haplo-HCT were limited to those receiving graft-versus-host disease (GVHD) prophylaxis with PTCy. GVHD prophylaxis in MSD was limited to calcineurin inhibitor (CNI)–based approaches without in vivo TCD, while MUD recipients received CNI-based prophylaxis with or without TCD. Outcome analyses for overall survival (OS) and progression-free survival (PFS), nonrelapse mortality (NRM), and disease relapse/progression were calculated. A total of 1438 patients (haplo, 132; MSD, 525; MUD TCD+, 403; and MUD TCD−, 378) were included. Patients with haplo donors were significantly older, had a better performance status and had more frequently received total body irradiation-based conditioning regimens and bone marrow grafts than MSD and MUD TCD+ or TCD−. 3-year OS, PFS, NRM and relapse/progression incidence after haplo-HCT was 46%, 38%, 22%, and 41%, respectively, and not significantly different from outcomes of matched donor transplants on multivariate analyses. Haplo-HCT was associated with a lower cumulative incidence of chronic GVHD compared with MSD, MUD TCD+/TCD−. NMC/RIC haplo-HCT with PTCy seems to be a valuable alternative for patients with DLBCL considered for allo-HCT but lacking a matched donor.

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

“…The final analysis included 17 studies ( Figure 1). One study was a prospective phase 2 trial [19], while the remaining 16 studies were retrospective multi-center, registry, or single-center studies [14,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]. This included 13957 patients who underwent Haplo-SCT (2012 patients) or MUD-SCT (11945 patients).…”

High‐dose post‐transplant cyclophosphamide impairs γδ T‐cell reconstitution after haploidentical haematopoietic stem cell transplantation using low‐dose antithymocyte globulin and peripheral blood stem cell graft

“…1 Fortunately, development of Haplo-HCT using post-transplant cyclophosphamide (PTCy) significantly improved the rates of graft-versushost disease (GvHD), non-relapse mortality and engraftment. [2][3][4][5][6][7] Compared with Allo-HCT with matched related or unrelated donor, retrospectives studies reported similar overall survival (OS) and disease-free survival (DFS) with Haplo-HCT and even sometimes a decreased incidence of acute and/or chronic GvHD. [2][3][4][5][6][7] PTCy acts through induction of functional impairment of alloreactive T cells without toxic effects on haematopoietic stem cells.…”

RBC and platelet transfusion support in the first 30 and 100 days after haploidentical hematopoietic stem cell transplantation

“…RESULTS: Nearly all (98.4%) patients were transfused in the first 30 days, and 59.2% were transfused between days 31 and 100. Among the transfused patients, medians of 5 units (interquartile range [IQR] = 3-8) of RBCs and 11 units (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) platelets were given in the first 30 days, and medians of 3 units (IQR = 1-7) of RBCs and 6 units (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) of platelets were transfused between days 31 and 100. Median times for achieving RBC and platelet transfusion independence were 34 (95% CI: [28][29][30][31][32][33][34][35][36][37][38][39][40]) and 25 (95% CI: 23-27) days, respectively.…”

“…1 Multiple single center and registry-based studies have compared transplant outcomes (including engraftment, relapse, survival, incidence, and severity of graft-versus-host disease [GVHD]), of haplo-HSCT recipients to MRD and MUD recipients with a variety of hematological diseases, and the results thus far have been encouraging and favorable. [7][8][9][10][11][12][13][14][15][16] Further prospective and retrospectives studies are still ongoing.…”