PTCY-Based Haploidentical Donor Transplantation versus HLA-Matched Related and Unrelated Donor Transplantations in Patients with Refractory or Relapsed Lymphoma—A Matched-Pair Analysis

• Published in: Cancers 2023-11, Vol.15 (21), p.5246
• Main Authors: Haebe, Sarah, Fraccaroli, Alessia, Stauffer, Elena, Prevalsek, Dusan, Zoellner, Anna K., Drolle, Heidrun, Stemmler, Hans-Joachim, Dreyling, Martin, von Bergwelt-Baildon, Michael, Tischer, Johanna
• Format: Article
• Language: English
• Subjects: Allografts; Care and treatment; Chemotherapy; Cyclophosphamide; Disease prevention; Diseases; Donors; Graft versus host disease; Graft-versus-host reaction; Health aspects; Hematology; Hematopoietic stem cells; Histocompatibility antigen HLA; Infections; Lymphocytes; Lymphocytes T; Lymphoma; Mortality; Non-Hodgkin's lymphoma; Non-Hodgkin's lymphomas; Patients; Prophylaxis; Relapse; Remission; Stem cell transplantation; Stem cells; T cells; Toxicity; Transplantation; Transplants & implants
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers15215246

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) has demonstrated its potential as a curative option for patients with r/r lymphoma. With the introduction of post-transplant cyclophosphamide-based (PTCY) graft-versus-host disease (GvHD) prophylaxis, allo-HCT using haploidentical related donors (Haplo-HSCT) has emerged as a valuable alternative for patients without an available HLA-matched donor. In this study, we compared intermediate and long-term outcomes between Haplo-HSCT and HLA-matched related donor (MRD) and unrelated donor (URD) transplantations in 16 matched pairs using age, disease status, lymphoma classification and performance status as matching criteria. Of note, 88% of patients in each group presented with active disease at the time of conditioning. After a median follow-up of >10 years, 10-year overall and progression-free survival and non-relapse mortality incidence after Haplo-HSCT were 31%, 25% and 38%, respectively, and did not differ compared to the values observed in MRD-HSCT and URD-HSCT. A remarkable lower incidence of acute GvHD ≥ II and moderate and severe chronic GvHD was observed after Haplo-HSCT compared to MRD-HSCT (50%/50%, p = 0.03/0.03) and URD-HSCT (44%/38%, p = 0.04/0.08), resulting in slightly higher 10-year GvHD-free and relapse-free survival (25%) and chronic GvHD-free and relapse-free survival (25%) in the Haplo-HSCT group. In conclusion, Haplo-HSCT is an effective treatment in patients with non-remission NHL. Given its advantage of immediate availability, haploidentical donors should be preferably used in patients with progressive disease lacking an HLA-matched related donor.