PTCy-based haploidentical vs matched related or unrelated donor reduced-intensity conditioning transplant for DLBCL

• Published in: Blood advances Vol. 3; no. 3; pp. 360 - 369
• Main Authors: Dreger, Peter, Sureda, Anna, Ahn, Kwang Woo, Eapen, Mary, Litovich, Carlos, Finel, Herve, Boumendil, Ariane, Gopal, Ajay, Herrera, Alex F., Schmid, Christoph, Diez-Martin, José Luis, Fuchs, Ephraim, Bolaños-Meade, Javier, Gooptu, Mahasweta, Al Malki, Monzr M., Castagna, Luca, Ciurea, Stefan O., Dominietto, Alida, Blaise, Didier, Ciceri, Fabio, Tischer, Johanna, Corradini, Paolo, Montoto, Silvia, Robinson, Stephen, Gülbas, Zafer, Hamadani, Mehdi
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 12.02.2019; American Society of Hematology
• Subjects: Adult; Aged; Female; Hematopoietic Stem Cell Transplantation - methods; Humans; Lymphoma, Large B-Cell, Diffuse - therapy; Male; Middle Aged; Retrospective Studies; Tissue Donors; Transplantation; Transplantation Conditioning - methods; Young Adult
• ISSN: 2473-9529; 2473-9537
• DOI: 10.1182/bloodadvances.2018027748

This study retrospectively compared long-term outcomes of nonmyeloablative/reduced intensity conditioning (NMC/RIC) allogeneic hematopoietic cell transplantation (allo-HCT) from a haploidentical family donor (haplo-HCT) using posttransplant cyclophosphamide (PTCy) with those of matched sibling donor (MSD) and matched unrelated donor (MUD) with or without T-cell depletion (TCD+/TCD−) in patients with relapsed diffuse large B-cell lymphoma (DLBCL). Adult patients with DLBCL who had undergone their first NMC/RIC allo-HCT between 2008 and 2015 were included. Recipients of haplo-HCT were limited to those receiving graft-versus-host disease (GVHD) prophylaxis with PTCy. GVHD prophylaxis in MSD was limited to calcineurin inhibitor (CNI)–based approaches without in vivo TCD, while MUD recipients received CNI-based prophylaxis with or without TCD. Outcome analyses for overall survival (OS) and progression-free survival (PFS), nonrelapse mortality (NRM), and disease relapse/progression were calculated. A total of 1438 patients (haplo, 132; MSD, 525; MUD TCD+, 403; and MUD TCD−, 378) were included. Patients with haplo donors were significantly older, had a better performance status and had more frequently received total body irradiation-based conditioning regimens and bone marrow grafts than MSD and MUD TCD+ or TCD−. 3-year OS, PFS, NRM and relapse/progression incidence after haplo-HCT was 46%, 38%, 22%, and 41%, respectively, and not significantly different from outcomes of matched donor transplants on multivariate analyses. Haplo-HCT was associated with a lower cumulative incidence of chronic GVHD compared with MSD, MUD TCD+/TCD−. NMC/RIC haplo-HCT with PTCy seems to be a valuable alternative for patients with DLBCL considered for allo-HCT but lacking a matched donor. [Display omitted]