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. 2021 Dec;27(12):1003.e1-1003.e13.
doi: 10.1016/j.jtct.2021.09.003. Epub 2021 Sep 16.

Bone Marrow versus Peripheral Blood Grafts for Haploidentical Hematopoietic Cell Transplantation with Post-Transplantation Cyclophosphamide

Rohtesh S Mehta  1 , Rima M Saliba  2 , Leonard C Alsfeld  2 , Jeffrey L Jorgensen  3 , Sa A Wang  3 , Paolo Anderlini  2 , Gheath Al-Atrash  2 , Qaiser Bashir  2 , Stefan O Ciurea  4 , Chitra M Hosing  2 , Jin S Im  2 , Partow Kebriaei  2 , Issa Khouri  2 , David Marin  2 , Yago Nieto  2 , Amanda Olson  2 , Betul Oran  2 , Uday R Popat  2 , Muzaffar H Qazilbash  2 , Jeremy Ramdial  2 , Gabriela Rondon  2 , Neeraj Saini  2 , Samer A Srour  2 , Katayoun Rezvani  2 , Elizabeth J Shpall  2 , Richard E Champlin  2 , Amin M Alousi  2
Affiliations

Bone Marrow versus Peripheral Blood Grafts for Haploidentical Hematopoietic Cell Transplantation with Post-Transplantation Cyclophosphamide

Rohtesh S Mehta et al. Transplant Cell Ther. 2021 Dec.

Abstract

In the coronavirus disease 19 (COVID-19) pandemic era, the number of haploidentical hematopoietic cell transplantations (HCTs) with peripheral blood (PB) grafts increased significantly compared with HCTs with bone marrow (BM) grafts, which may be associated with adverse outcomes. We compared outcomes of HCT in BM graft and PB graft recipients age ≥18 years with hematologic malignancies who underwent T cell- replete haploidentical HCT and received graft-versus-host disease (GVHD) prophylaxis with post-transplantation cyclophosphamide, tacrolimus, and mycophenolate mofetil. Among the 264 patients, 180 (68%) received a BM graft and 84 (32%) received a PB graft. The median patient age was 50 years in both groups. The majority (n = 199; 75%) received reduced-intensity conditioning. The rate of acute leukemia or myelodysplastic syndrome was higher in the BM graft recipients compared with the PB graft recipients (85% [n = 152] versus 55% [n = 46]; P < .01). The median times to neutrophil and platelet engraftment and the incidence of grade II-IV and grade III-IV acute GVHD (aGVHD) were comparable in the 2 groups. Among the patients with grade II-IV aGVHD, the rate of steroid-refractory aGVHD was 9% (95% confidence interval [CI], 5% to 18%) in the BM group versus 32% (95% CI, 19% to 54%) in the PB group (hazard ratio [HR], 3.7, 95% CI, 1.5 to 9.3; P = .006). At 1 year post-HCT, the rate of chronic GVHD (cGVHD) was 8% (95% CI, 4% to 13%) in the BM group versus 22% (95% CI, 14% to 36%) in the PB group (HR, 3.0; 95% CI, 1.4-6.6; P = .005), and the rate of systemic therapy-requiring cGVHD was 2.5% (95% CI, 1% to 7%) versus 14% (95% CI, 7% to 27%), respectively (HR, 5.6; 95% CI, 1.7 to 18; P = .004). The PB group had a significantly higher risk of bacterial and viral infections, with no appreciable advantage in the duration of hospitalization, immune reconstitution, relapse, nonrelapse mortality, or survival. Our data suggest a benefit of the use of BM grafts over PB grafts for haplo-HCT.

Keywords: Bone marrow; Chronic GVHD; Haploidentical; PTCy; Peripheral blood; Steroid-refractory GVHD.

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Figures

Figure 1
Figure 1
Cumulative incidence of acute GVHD grade II-IV (A), grade III-IV (B), and SR (C) in recipients of BM grafts (blue) and PB grafts (red).
Figure 2
Figure 2
Cumulative incidence of overall chronic GVHD (A) and systemic therapy-requiring grade chronic GVHD (B) in recipients of BM grafts (blue) and PB grafts (red).
Figure 3
Figure 3
Other outcomes, including NRM (A), relapse/progression (B), PFS (C), OS (D), and GRFS (E ) in recipients of BM grafts (blue) and PB grafts (red).
Figure 3
Figure 3
Other outcomes, including NRM (A), relapse/progression (B), PFS (C), OS (D), and GRFS (E ) in recipients of BM grafts (blue) and PB grafts (red).
Figure 3
Figure 3
Other outcomes, including NRM (A), relapse/progression (B), PFS (C), OS (D), and GRFS (E ) in recipients of BM grafts (blue) and PB grafts (red).
Figure 3
Figure 3
Other outcomes, including NRM (A), relapse/progression (B), PFS (C), OS (D), and GRFS (E ) in recipients of BM grafts (blue) and PB grafts (red).
Figure 3
Figure 3
Other outcomes, including NRM (A), relapse/progression (B), PFS (C), OS (D), and GRFS (E ) in recipients of BM grafts (blue) and PB grafts (red).
See this image and copyright information in PMC

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