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. 2020 Aug;26(8):1459-1468.
doi: 10.1016/j.bbmt.2020.05.001. Epub 2020 May 17.

Risk Factors for Graft-versus-Host Disease in Haploidentical Hematopoietic Cell Transplantation Using Post-Transplant Cyclophosphamide

Annie Im  1 , Armin Rashidi  2 , Tao Wang  3 , Michael Hemmer  4 , Margaret L MacMillan  5 , Joseph Pidala  6 , Madan Jagasia  7 , Steven Pavletic  8 , Navneet S Majhail  9 , Daniel Weisdorf  2 , Hisham Abdel-Azim  10 , Vaibhav Agrawal  11 , A Samer Al-Homsi  12 , Mahmoud Aljurf  13 , Medhat Askar  14 , Jeffery J Auletta  15 , Asad Bashey  16 , Amer Beitinjaneh  17 , Vijaya Raj Bhatt  18 , Michael Byrne  7 , Jean-Yves Cahn  19 , Mitchell Cairo  20 , Paul Castillo  21 , Jan Cerny  22 , Saurabh Chhabra  4 , Hannah Choe  23 , Stefan Ciurea  24 , Andrew Daly  25 , Miguel Angel Diaz Perez  26 , Nosha Farhadfar  27 , Shahinaz M Gadalla  28 , Robert Gale  29 , Siddhartha Ganguly  30 , Usama Gergis  31 , Rabi Hanna  32 , Peiman Hematti  33 , Roger Herzig  34 , Gerhard C Hildebrandt  35 , Deepesh P Lad  36 , Catherine Lee  37 , Leslie Lehmann  38 , Lazaros Lekakis  17 , Rammurti T Kamble  39 , Mohamed A Kharfan-Dabaja  40 , Pooja Khandelwal  41 , Rodrigo Martino  42 , Hemant S Murthy  40 , Taiga Nishihori  43 , Tracey A O'Brien  44 , Richard F Olsson  45 , Sagar S Patel  46 , Miguel-Angel Perales  47 , Tim Prestidge  48 , Muna Qayed  49 , Rizwan Romee  50 , Hélène Schoemans  51 , Sachiko Seo  52 , Akshay Sharma  53 , Melhem Solh  54 , Roger Strair  55 , Takanori Teshima  56 , Alvaro Urbano-Ispizua  57 , Marjolein Van der Poel  58 , Ravi Vij  59 , John L Wagner  60 , Basem William  61 , Baldeep Wirk  62 , Jean A Yared  63 , Steve R Spellman  4 , Mukta Arora  2 , Betty K Hamilton  64
Affiliations

Risk Factors for Graft-versus-Host Disease in Haploidentical Hematopoietic Cell Transplantation Using Post-Transplant Cyclophosphamide

Annie Im et al. Biol Blood Marrow Transplant. 2020 Aug.

Abstract

Post-transplant cyclophosphamide (PTCy) has significantly increased the successful use of haploidentical donors with a relatively low incidence of graft-versus-host disease (GVHD). Given its increasing use, we sought to determine risk factors for GVHD after haploidentical hematopoietic cell transplantation (haplo-HCT) using PTCy. Data from the Center for International Blood and Marrow Transplant Research on adult patients with acute myeloid leukemia, acute lymphoblastic leukemia, myelodysplastic syndrome, or chronic myeloid leukemia who underwent PTCy-based haplo-HCT (2013 to 2016) were analyzed and categorized into 4 groups based on myeloablative (MA) or reduced-intensity conditioning (RIC) and bone marrow (BM) or peripheral blood (PB) graft source. In total, 646 patients were identified (MA-BM = 79, MA-PB = 183, RIC-BM = 192, RIC-PB = 192). The incidence of grade 2 to 4 acute GVHD at 6 months was highest in MA-PB (44%), followed by RIC-PB (36%), MA-BM (36%), and RIC-BM (30%) (P = .002). The incidence of chronic GVHD at 1 year was 40%, 34%, 24%, and 20%, respectively (P < .001). In multivariable analysis, there was no impact of stem cell source or conditioning regimen on grade 2 to 4 acute GVHD; however, older donor age (30 to 49 versus <29 years) was significantly associated with higher rates of grade 2 to 4 acute GVHD (hazard ratio [HR], 1.53; 95% confidence interval [CI], 1.11 to 2.12; P = .01). In contrast, PB compared to BM as a stem cell source was a significant risk factor for the development of chronic GVHD (HR, 1.70; 95% CI, 1.11 to 2.62; P = .01) in the RIC setting. There were no differences in relapse or overall survival between groups. Donor age and graft source are risk factors for acute and chronic GVHD, respectively, after PTCy-based haplo-HCT. Our results indicate that in RIC haplo-HCT, the risk of chronic GVHD is higher with PB stem cells, without any difference in relapse or overall survival.

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Conflict of interest statement

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

Figures

Figure 1.
Figure 1.
Incidence of Acute GVHD II-IV by conditioning intensity and graft source.
Figure 2.
Figure 2.
Incidence of Chronic GVHD by conditioning intensity and graft source.
Figure 3.
Figure 3.
Incidence of Relapse by conditioning intensity and graft source.
Figure 4.
Figure 4.
Incidence of Non-relapse mortality by conditioning intensity and graft source.
Figure 5.
Figure 5.
GVHD-free, relapse free survival by conditioning intensity and graft source.
See this image and copyright information in PMC

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