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. 2019 Sep 10;3(17):2608-2616.
doi: 10.1182/bloodadvances.2019000155.

Haploidentical transplantation using posttransplant cyclophosphamide as GVHD prophylaxis in patients over age 70

Philip H Imus  1 , Hua-Ling Tsai  2 , Leo Luznik  1 , Ephraim J Fuchs  1 , Carol Ann Huff  1 , Douglas E Gladstone  1 , Patrick Lowery  1 , Richard F Ambinder  1 , Ivan M Borrello  1 , Lode J Swinnen  1 , Nina Wagner-Johnston  1 , Christian B Gocke  1 , Syed Abbas Ali  1 , F Javier Bolaños-Meade  1 , Ravi Varadhan  2 , Richard J Jones  1
Affiliations

Haploidentical transplantation using posttransplant cyclophosphamide as GVHD prophylaxis in patients over age 70

Philip H Imus et al. Blood Adv. .

Abstract

Hematologic malignancies in older people are unlikely to be cured with chemotherapy alone. Advances in allogeneic blood or marrow transplantation (alloBMT), especially nonmyeloablative (NMA) conditioning and the use of haploidentical donors, now make this therapy available to older people; however, long-term outcomes and predictors of success are unclear. We reviewed the outcomes of 93 consecutive patients aged 70 and older (median, 72; range, 70-78), who underwent haploidentical BMT at Johns Hopkins Hospital between 1 September 2009 and 1 April 2018. All patients received NMA conditioning and posttransplantation cyclophosphamide (PTCy) as graft-versus-host disease (GVHD) prophylaxis. The 2-year overall survival was 53%, and 2-year event-free survival was 43%. The 180-day cumulative incidence (CuI) of nonrelapse mortality (NRM) was 14%, and the 2-year CuI was 27%. The 2-year CuI of relapse was 30%. Of 78 patients who were alive and had their weight recorded on day 180, weight loss predicted subsequent NRM (subdistribution hazard ratio, 1.0; 95% CI, 1-1.13; P = .048). In conclusion, haploidentical BMT with PTCy is feasible and relatively safe in septuagenarians. Although early, 6-month NRM was relatively low at 14%, but overall NRM continued to climb to 27% at 2 years, at least in part because of late deaths that appeared to be somewhat age related. Further studies to elucidate predictors of NRM are warranted.

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Conflict of interest statement

Conflict-of-interest disclosure: The authors declare no competing financial interests.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
CuI of GVHD. CuI of acute (A) and chronic (B) GVHD.
Figure 2.
Figure 2.
Outcomes of patients aged 70 and older who underwent allogeneic BMT. Kaplan-Meier curves of OS and PFS (A) and CuI of NRM and relapse (B).
Figure 3.
Figure 3.
Mortality and weight loss. Hazard function of OS (A) and cause-specific hazard function of NRM (B) by weight loss (continuous per 1 kg). Three knots for weight loss, as a restricted cubic spline function, were selected based on the lowest Akaike Information Criteria.
Figure 4.
Figure 4.
Association of hospitalization with survival. OS (A) and NRM (B) of patients aged 70 and older after haploidentical BMT according to days hospitalized between neutrophil recovery and day 180.
See this image and copyright information in PMC

References

    1. Sant M, Allemani C, Tereanu C, et al. ; HAEMACARE Working Group . Incidence of hematologic malignancies in Europe by morphologic subtype: results of the HAEMACARE project. Blood. 2010;116(19):3724-3734. - PubMed
    1. Döhner H, Estey E, Grimwade D, et al. . Diagnosis and management of AML in adults: 2017 ELN recommendations from an international expert panel. Blood. 2017;129(4):424-447. - PMC - PubMed
    1. Vasu S, Kohlschmidt J, Mrózek K, et al. . Ten-year outcome of patients with acute myeloid leukemia not treated with allogeneic transplantation in first complete remission. Blood Adv. 2018;2(13):1645-1650. - PMC - PubMed
    1. Artz AS. From biology to clinical practice: aging and hematopoietic cell transplantation. Biol Blood Marrow Transplant. 2012;18(1 suppl):S40-S45. - PubMed
    1. Alyea EP, Kim HT, Ho V, et al. . Comparative outcome of nonmyeloablative and myeloablative allogeneic hematopoietic cell transplantation for patients older than 50 years of age. Blood. 2005;105(4):1810-1814. - PubMed

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