Reduced-intensity transplantation for lymphomas using haploidentical related donors vs HLA-matched unrelated donors

• Published in: Blood 2016-02, Vol.127 (7), p.938-947
• Main Authors: Kanate, Abraham S., Mussetti, Alberto, Kharfan-Dabaja, Mohamed A., Ahn, Kwang W., DiGilio, Alyssa, Beitinjaneh, Amer, Chhabra, Saurabh, Fenske, Timothy S., Freytes, Cesar, Gale, Robert Peter, Ganguly, Siddhartha, Hertzberg, Mark, Klyuchnikov, Evgeny, Lazarus, Hillard M., Olsson, Richard, Perales, Miguel-Angel, Rezvani, Andrew, Riches, Marcie, Saad, Ayman, Slavin, Shimon, Smith, Sonali M., Sureda, Anna, Yared, Jean, Ciurea, Stefan, Armand, Philippe, Salit, Rachel, Bolaños-Meade, Javier, Hamadani, Mehdi
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Allografts; Antilymphocyte Serum - administration & dosage; Chronic Disease; Cyclophosphamide - administration & dosage; Disease-Free Survival; Female; Graft vs Host Disease - mortality; Graft vs Host Disease - prevention & control; Hematopoietic Stem Cell Transplantation; Histocompatibility Testing; Humans; Lymphoma - mortality; Lymphoma - therapy; Male; Medicin och hälsovetenskap; Middle Aged; Survival Rate; Transplantation; Transplantation Conditioning; Unrelated Donors
• ISSN: 0006-4971; 1528-0020; 1528-0020
• DOI: 10.1182/blood-2015-09-671834

We evaluated 917 adult lymphoma patients who received haploidentical (n = 185) or HLA-matched unrelated donor (URD) transplantation either with (n = 241) or without antithymocyte globulin (ATG; n = 491) following reduced-intensity conditioning regimens. Haploidentical recipients received posttransplant cyclophosphamide-based graft-versus-host disease (GVHD) prophylaxis, whereas URD recipients received calcineurin inhibitor-based prophylaxis. Median follow-up of survivors was 3 years. The 100-day cumulative incidence of grade III-IV acute GVHD on univariate analysis was 8%, 12%, and 17% in the haploidentical, URD without ATG, and URD with ATG groups, respectively (P = .44). Corresponding 1-year rates of chronic GVHD on univariate analysis were 13%, 51%, and 33%, respectively (P < .001). On multivariate analysis, grade III-IV acute GVHD was higher in URD without ATG (P = .001), as well as URD with ATG (P = .01), relative to haploidentical transplants. Similarly, relative to haploidentical transplants, risk of chronic GVHD was higher in URD without ATG and URD with ATG (P < .0001). Cumulative incidence of relapse/progression at 3 years was 36%, 28%, and 36% in the haploidentical, URD without ATG, and URD with ATG groups, respectively (P = .07). Corresponding 3-year overall survival (OS) was 60%, 62%, and 50% in the 3 groups, respectively, with multivariate analysis showing no survival difference between URD without ATG (P = .21) or URD with ATG (P = .16), relative to haploidentical transplants. Multivariate analysis showed no difference between the 3 groups in terms of nonrelapse mortality (NRM), relapse/progression, and progression-free survival (PFS). These data suggest that reduced-intensity conditioning haploidentical transplantation with posttransplant cyclophosphamide does not compromise early survival outcomes compared with matched URD transplantation, and is associated with significantly reduced risk of chronic GVHD. •Risk of grade III-IV acute and chronic GVHD is significantly lower with haploidentical compared with URD transplantation.•Relapse risk, NRM, PFS, and OS was similar in haploidentical transplants compared with unrelated donor transplants.