TY - JOUR
T1 - Related donor transplants
T2 - Has posttransplantation cyclophosphamide nullified the detrimental effect of HLA mismatch?
AU - Acute Leukemia Working Party of the European Society for Blood and Marrow Transplant
AU - Center for International Blood and Marrow Transplant Research
AU - Robinson, Tara M.
AU - Fuchs, Ephraim J.
AU - Zhang, Mei Jie
AU - St. Martin, Andrew
AU - Labopin, Myriam
AU - Keesler, Daniel A.
AU - Blaise, Didier
AU - Bashey, Asad
AU - Bourhis, Jean Henri
AU - Ciceri, Fabio
AU - Ciurea, Stefan O.
AU - Devine, Steven M.
AU - Mohty, Mohamad
AU - McCurdy, Shannon R.
AU - Milpied, Noel
AU - McNiece, Ian K.
AU - Rocha, Vanderson
AU - Romee, Rizwan
AU - Socie, Gerard
AU - Yakoub-Agha, Ibrahim
AU - Soiffer, Robert J.
AU - Eapen, Mary
AU - Nagler, Arnon
N1 - Publisher Copyright:
© 2018 by The American Society of Hematology.
PY - 2018/6/12
Y1 - 2018/6/12
N2 - We sought to identify whether posttransplantation cyclophosphamide (PT-Cy) reduces or eliminates the detrimental impact of HLA mismatching on outcomes of HLA-haploidentical related donor transplantation for acute leukemia. Data from 2143 donor-recipient pairs (n = 218 haploidentical sibling; n = 218 offspring; n = 1707 HLA-matched sibling) with acute myeloid or lymphoblastic leukemia were studied. All received a calcineurin inhibitor for graft-versus-host disease (GVHD) prophylaxis while high-dose PT-Cy was also given to recipients of haploidentical transplant. Patient age correlated with donor-recipient relationship: haploidentical siblings donated to patients aged 18 to 54 years whereas offspring donated to patients aged 55 to 76 years. Therefore, transplant outcomes were examined separately in the 2 patient age groups. In patients aged 18 to 54 years, there were no significant differences in outcomes except chronic GVHD, which was lower after haploidentical sibling compared to HLA-matched sibling transplant (hazard ratio [HR], 0.63; P, .001). In patients aged 55 to 76 years, despite lower chronic GVHD (HR, 0.42; P, .001), graft failure (14% vs 6%; P = .003), nonrelapse mortality (HR, 1.48; P = .02), and overall mortality (HR, 1.32; P = .003) were higher after transplant from offspring compared with an HLA-matched sibling. These data demonstrate a superior outcome in older recipients when using an HLA-matched sibling instead of offspring, although there were differences in transplant platforms (GVHD prophylaxis and graft type) between the 2 groups. Validation of these findings requires a prospective randomized trial wherein the transplant platforms can be closely matched.
AB - We sought to identify whether posttransplantation cyclophosphamide (PT-Cy) reduces or eliminates the detrimental impact of HLA mismatching on outcomes of HLA-haploidentical related donor transplantation for acute leukemia. Data from 2143 donor-recipient pairs (n = 218 haploidentical sibling; n = 218 offspring; n = 1707 HLA-matched sibling) with acute myeloid or lymphoblastic leukemia were studied. All received a calcineurin inhibitor for graft-versus-host disease (GVHD) prophylaxis while high-dose PT-Cy was also given to recipients of haploidentical transplant. Patient age correlated with donor-recipient relationship: haploidentical siblings donated to patients aged 18 to 54 years whereas offspring donated to patients aged 55 to 76 years. Therefore, transplant outcomes were examined separately in the 2 patient age groups. In patients aged 18 to 54 years, there were no significant differences in outcomes except chronic GVHD, which was lower after haploidentical sibling compared to HLA-matched sibling transplant (hazard ratio [HR], 0.63; P, .001). In patients aged 55 to 76 years, despite lower chronic GVHD (HR, 0.42; P, .001), graft failure (14% vs 6%; P = .003), nonrelapse mortality (HR, 1.48; P = .02), and overall mortality (HR, 1.32; P = .003) were higher after transplant from offspring compared with an HLA-matched sibling. These data demonstrate a superior outcome in older recipients when using an HLA-matched sibling instead of offspring, although there were differences in transplant platforms (GVHD prophylaxis and graft type) between the 2 groups. Validation of these findings requires a prospective randomized trial wherein the transplant platforms can be closely matched.
UR - http://www.scopus.com/inward/record.url?scp=85051130706&partnerID=8YFLogxK
U2 - 10.1182/bloodadvances.2018018291
DO - 10.1182/bloodadvances.2018018291
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C2 - 29794073
AN - SCOPUS:85051130706
SN - 2473-9529
VL - 2
SP - 1180
EP - 1186
JO - Blood advances
JF - Blood advances
IS - 11
ER -