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

Publication Type:

Journal Article

Source:

Blood (2015)

Abstract:

We evaluated 917 adult lymphoma patients who received haploidentical (n=185) or HLA-matched unrelated donor (URD) transplantation either with (n=241) or without anti-thymocyte globulin (ATG; n=491), following reduced-intensity conditioning regimens. Haploidentical recipients received post-transplant 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=0.44. Corresponding 1-year rates of chronic GVHD on univariate-analysis were 13%, 51% and 33% respectively, p<0.001. On multivariate analysis grade III-IV acute GVHD was higher in URD without ATG (p=0.001), as well as URD with ATG (p=0.01), relative to haploidentical transplants. Similarly, relative to haploidentical transplants risk of chronic GVHD was higher in URD without ATG and URD with ATG (p<0.0001). 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=0.07. Corresponding 3-year overall survival was 60%, 62% and 50% in the three groups, respectively, with multivariate analysis showing no survival difference between URD without ATG (p=0.21) or URD with ATG (p=0.16), relative to haploidentical transplants. Multivariate analysis showed no difference between the three groups in terms of non-relapse mortality, relapse/progression and progression-free survival. These data suggest that, reduced-intensity conditioning haploidentical transplantation with post-transplant cyclophosphamide does not compromise early survival outcomes compared to matched URD transplantation, and is associated with significantly reduced risk of chronic GVHD.