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. 2024 Dec 10;8(23):6104-6113.
doi: 10.1182/bloodadvances.2024013719.

Outcomes of haploidentical transplants with PT-CY vs 10/10 MUD transplants with ATG in Germany

Aysenur Arslan  1   2 , Svenja Labuhn  3 , Elisa Sala  4 , Mark Ringhoffer  5 , Johannes Schetelig  6   7 , Thomas Schröder  8 , Gesine Bug  9 , Georg-Nikolaus Franke  10 , Matthias Stelljes  11 , Peter Dreger  12 , Robert Zeiser  13 , Daniel Teschner  14 , Wolfgang Bethge  15 , Matthias Eder  16 , Matthias Edinger  17 , Elisa Maria Amann  1   2 , Christine Neuchel  1   2 , Amelie Schmid-Möglich  1   2 , Sandra Schmeller  3 , Jan Beyersmann  3 , Hubert Schrezenmeier  1   2 , Joannis Mytilineos  18 , Nicolaus Kröger  19 , Daniel Fürst  1   2
Affiliations

Outcomes of haploidentical transplants with PT-CY vs 10/10 MUD transplants with ATG in Germany

Aysenur Arslan et al. Blood Adv. .

Abstract

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the best curative treatment modality for many malignant hematologic disorders. In the absence of a matched related donor, matched unrelated donors (MUDs) and haploidentical donors are the most important stem cell sources. In this registry-based retrospective study, we compared the outcomes of allo-HSCTs from 10/10 MUDs with antithymocyte globulin (ATG)-based regimens (n = 7050) vs haploidentical transplants (Haplo-Tx) using posttransplant cyclophosphamide (PT-CY Haplo; n = 487) in adult patients with hematologic malignancies between 2010 and 2020. Cox proportional hazard-and competing risks regression models were formed to compare the outcomes. Overall survival (OS), Disease-free survival (DFS), and graft-versus-host disease (GVHD)-free and relapse-free survival (GRFS) were superior for 10/10 MUDs (OS [hazard ratio (HR), 1.27; 95% confidence interval (CI), 1.10-1.47; P = .001]; DFS [HR, 1.17; CI, 1.02-1.34; P = .022]; GRFS [HR, 1.34; CI, 1.19-1.50; P < .001]). The risk of acute GVHD (aGVHD) grade 2 to 4, aGVHD grade 3 to 4, and chronic GVHD (cGVHD) was higher in the PT-CY Haplo group than the 10/10 MUD group (aGVHD grade 2-4 [HR, 1.46; CI, 1.25-1.71; P < .001]; aGVHD grade 3-4 [HR, 1.74; CI, 1.37- 2.20; P < .001]; cGVHD [HR, 1.30; CI, 1.11-1.51; P = .001]). A lower incidence of relapse was observed in the PT-CY Haplo group (relapse: HR, 0.83; CI, 0.69-0.99; P = .038). Unrelated 10/10 matched transplantation with ATG leads to lower GVHD rates and improved survival rates compared with PT-CY Haplo transplantation in Germany.

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Conflict of interest statement

Conflict-of-interest disclosure: R.Z. received honoraria from Novartis, Incyte, Mallinckrodt Pharmaceuticals, Sanofi, medac, and Neovii. The remaining authors declare no competing financial interests.

A complete list of the members of the German Registry of Stem Cell Transplantation study group appears in “Appendix.”

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Overall Survival. Unadjusted 5-year OS according to transplant type (P = .006).
Figure 2.
Figure 2.
GvHD and Relapse Free Survival. Unadjusted 5-year GRFS according to transplant type (P < .001).
Figure 3.
Figure 3.
aGvHD Incidences. (A) Unadjusted 1-year aGVHD °2 to 4 incidence according to transplant type (P < .001). (B) Unadjusted 1-year aGVHD °3 to 4 incidence according to transplant type (P < .001).
Figure 4.
Figure 4.
Non-relapse Mortality. Unadjusted 5-year NRM incidence according to transplant type (P = .001).
Figure 5.
Figure 5.
Relapse Incidence. Unadjusted 5-year relapse incidence according to transplant type (P = .481).
See this image and copyright information in PMC

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