Reduced-Intensity Transplantation for Lymphomas Using Haploidentical Related Donors Versus HLA-Matched Sibling Donors: A Center for International Blood and Marrow Transplant Research Analysis

Abstract

Purpose: Related donor haploidentical hematopoietic cell transplantation (Haplo-HCT) using post-transplantation cyclophosphamide (PT-Cy) is increasingly used in patients lacking HLA-matched sibling donors (MSD). We compared outcomes after Haplo-HCT using PT-Cy with MSD-HCT in patients with lymphoma, using the Center for International Blood and Marrow Transplant Research registry.

Materials and methods: We evaluated 987 adult patients undergoing either Haplo-HCT (n = 180) or MSD-HCT (n = 807) following reduced-intensity conditioning regimens. The haploidentical group received graft-versus-host disease (GVHD) prophylaxis with PT-Cy with or without a calcineurin inhibitor and mycophenolate. The MSD group received calcineurin inhibitor-based GVHD prophylaxis.

Results: Median follow-up of survivors was 3 years. The 28-day neutrophil recovery was similar in the two groups (95% v 97%; P = .31). The 28-day platelet recovery was delayed in the haploidentical group compared with the MSD group (63% v 91%; P = .001). Cumulative incidence of grade II to IV acute GVHD at day 100 was similar between the two groups (27% v 25%; P = .84). Cumulative incidence of chronic GVHD at 1 year was significantly lower after Haplo-HCT (12% v 45%; P < .001), and this benefit was confirmed on multivariate analysis (relative risk, 0.21; 95% CI, 0.14 to 0.31; P < .001). For Haplo-HCT v MSD-HCT, 3-year rates of nonrelapse mortality (15% v 13%; P = .41), relapse/progression (37% v 40%; P = .51), progression-free survival (48% v 48%; P = .96), and overall survival (61% v 62%; P = .82) were similar. Multivariate analysis showed no significant difference between Haplo-HCT and MSD-HCT in terms of nonrelapse mortality (P = .06), progression/relapse (P = .10), progression-free survival (P = .83), and overall survival (P = .34).

Conclusion: Haplo-HCT with PT-Cy provides survival outcomes comparable to MSD-HCT, with a significantly lower risk of chronic GVHD.

Fig 1.

(A) Cumulative incidence of grade III and IV acute graft-versus-host disease (GVHD) in recipients of haploidentical donor versus HLA-identical sibling donor allogeneic hematopoietic cell transplantation. (B) Cumulative incidence of chronic GVHD in recipients of haploidentical donor versus HLA-identical sibling donor allogeneic hematopoietic cell transplantation. (C) Cumulative incidence of nonrelapse mortality in recipients of haploidentical donor versus HLA-identical sibling donor allogeneic hematopoietic cell transplantation. (D) Cumulative incidence of lymphoma relapse/progression in recipients of haploidentical donor versus HLA-identical sibling donor allogeneic hematopoietic cell transplantation. (E) Progression-free survival in recipients of haploidentical donor versus HLA-identical sibling donor allogeneic hematopoietic cell transplantation. (F) Overall survival in recipients of haploidentical donor versus HLA-identical sibling donor allogeneic hematopoietic cell transplantation.