Abstract
Allogeneic hematopoietic cell transplantation (allo-HCT) from a haploidentical (haplo) donor has emerged as a suitable alternative in the absence of a matched donor. However, haplo-HCT patients have a higher risk of graft-versus-host disease (GVHD). Hence, bone marrow (BM) stem cell source and post-transplant cyclophosphamide (PTCy) have been routinely used to help mitigate this. Due to ease of collection, peripheral blood (PB) stem cells are increasingly being considered for haplo-HCT. We retrospectively analyzed 74 patients (42 BM and 32 PB) who underwent haplo-HCT at Ohio State University from 2009 to 2018. Median age at transplant was 60 years (yrs) for BM and 54 yrs for PB, (p = 0.45). There was no difference in OS (p = 0.13) and NRM (p = 0.75) as well as PFS (p = 0.10) or GRFS (p = 0.90) between the groups. The BM cohort showed a 3-year OS rate of 63% (95% confidence interval (CI): 46–76), and 3-year PFS of 49% (95% CI: 33–63). For the PB group, 3-year OS and PFS were 78% (95% CI: 59–89) and 68% (95% CI: 49–82), respectively. There were no differences in the incidence of acute GVHD (grade II-IV) (p = 0.31) and chronic GVHD (p = 0.18). Patients receiving BM had a significantly higher risk for relapse with relapse rates by 2 years at 36% (95% CI: 22–50) vs. 16% (95% CI: 6–31) for PB (p = 0.03). The findings from this study suggest that PB is an excellent alternative to BM for haplo-HCT.
Highlights
Allogeneic hematopoietic stem cell transplant is a potentially life-saving therapy for hematologic malignancies and other diseases
There were significant limitations including longlasting immunodeficiency resulting in extraordinary non-relapse mortality (NRM) linked to infection and inadequate anti-leukemia effects resulting in early relapsed disease
The incidence of NRM at one year was 12% in the bone marrow (BM) group vs. 16%
Summary
Allogeneic hematopoietic stem cell transplant (allo-HCT) is a potentially life-saving therapy for hematologic malignancies and other diseases. Is an optimal donor, but only 30% of people have such an available donor [1]. For those patients who do not have an MRD, search for matched unrelated donors (MUD) through donor registries such as the National Marrow Donor Program (NMDP) is the best option. Haploidentical (haplo) donor transplant offers a great alternative donor option due to its universal availability. The initial protocol developed for haplo-HCT involved profound T-cell depletion with myeloablative conditioning developed by the Perugia group [4]. There were significant limitations including longlasting immunodeficiency resulting in extraordinary non-relapse mortality (NRM) linked to infection and inadequate anti-leukemia effects resulting in early relapsed disease
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