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Reduced-Intensity Transplantation With Haploidentical Related Donors vs HLA-Matched Sibling Donors in Patients With Lymphoma

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Key Points

  • Haplo-HCT with post-transplantation cyclophosphamide was associated with a reduced risk of chronic graft-vs-host disease in patients with lymphoma.
  • Haplo-HCT and MSD-HCT were associated with similar nonrelapse mortality, relapse/progression, and progression-free and overall survival.

In an analysis of the observational data base of the Center for International Blood and Marrow Transplant Research reported in the Journal of Clinical Oncology, Ghosh et al found that lymphoma patients undergoing reduced-intensity conditioning had similar outcomes with related-donor haploidentical hematopoietic cell transplantation (haplo-HCT) and post-transplantation cyclophosphamide compared with HLA-matched sibling donor (MSD) HCT, with the former approach being associated with a reduced risk for chronic graft-vs-host disease.

Study Details

The study involved 987 adult patients undergoing either haplo-HCT (n = 180) or MSD-HCT (n = 807) after reduced-intensity conditioning regimens. The haplo-HCT group received graft-vs-host disease prophylaxis with post-transplantation cyclophosphamide with or without a calcineurin inhibitor and mycophenolate, and the MSD-HCT group received calcineurin inhibitor–based prophylaxis.

Outcomes

Median follow-up for survivors was 3 years. The 28-day neutrophil recovery was similar in the haplo-HCT and MSD-HCT groups (95% vs 97%, P = .31), whereas 28-day platelet recovery was delayed in the haplo-HCT group (63% vs 91%, P = .001). The cumulative incidence of grade II to IV acute graft-vs-host disease at day 100 was 27% vs 25% (P = .84); the cumulative incidence of chronic graft-vs-host disease at 1 year was 12% vs 45% (P < .001), with the benefit confirmed on multivariate analysis (relative risk = 0.21, P < .001).

For haplo-HCT vs MSD-HCT, 3-year rates were 15% vs 13% for nonrelapse mortality (P = .41; P = .06 on multivariate analysis), 37% vs 40% for relapse/progression (P = .51; P = .10), 48% vs 48% for progression-free survival (P = .96; P = .83), and 61% vs 62% for overall survival (P = .82; P = .34).

The investigators concluded: “Haplo-HCT with [post-transplantation cyclophosphamide] provides survival outcomes comparable to MSD-HCT, with a significantly lower risk of chronic graft-vs-host disease.”

Mehdi Hamadani, MD, of the Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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