PTCy-based haploidentical vs matched related or unrelated donor reduced-intensity conditioning transplant for DLBCL

Peter Dreger, Anna Sureda, Kwang Woo Ahn, Mary Eapen, Carlos Litovich, Herve Finel, Ariane Boumendil, Ajay Gopal, Alex F. Herrera, Christoph Schmid, José Luis Diez-Martin, Ephraim Fuchs, Javier Bolaños-Meade, Mahasweta Gooptu, Monzr M. Al Malki, Luca Castagna, Stefan O. Ciurea, Alida Dominietto, Didier Blaise, Fabio CiceriJohanna Tischer, Paolo Corradini, Silvia Montoto, Stephen Robinson, Zafer Gülbas, Mehdi Hamadani

Research output: Contribution to journalArticle

Abstract

This study retrospectively compared long-term outcomes of nonmyeloablative/reduced intensity conditioning (NMC/RIC) allogeneic hematopoietic cell transplantation (allo-HCT) from a haploidentical family donor (haplo-HCT) using posttransplant cyclophosphamide (PTCy) with those of matched sibling donor (MSD) and matched unrelated donor (MUD) with or without T-cell depletion (TCD+/TCD-) in patients with relapsed diffuse large B-cell lymphoma (DLBCL). Adult patients with DLBCL who had undergone their first NMC/RIC allo-HCT between 2008 and 2015 were included. Recipients of haplo-HCT were limited to those receiving graft-versus-host disease (GVHD) prophylaxis with PTCy. GVHD prophylaxis in MSD was limited to calcineurin inhibitor (CNI)-based approaches without in vivo TCD, while MUD recipients received CNI-based prophylaxis with or without TCD. Outcome analyses for overall survival (OS) and progression-free survival (PFS), nonrelapse mortality (NRM), and disease relapse/progression were calculated. A total of 1438 patients (haplo, 132; MSD, 525; MUD TCD+, 403; and MUD TCD-, 378) were included. Patients with haplo donors were significantly older, had a better performance status and had more frequently received total body irradiation-based conditioning regimens and bone marrow grafts than MSD and MUD TCD+ or TCD-. 3-year OS, PFS, NRM and relapse/progression incidence after haplo-HCT was 46%, 38%, 22%, and 41%, respectively, and not significantly different from outcomes of matched donor transplants on multivariate analyses. Haplo-HCT was associated with a lower cumulative incidence of chronic GVHD compared with MSD, MUD TCD+/TCD-. NMC/RIC haplo-HCT with PTCy seems to be a valuable alternative for patients with DLBCL considered for allo-HCT but lacking a matched donor.

Original languageEnglish
Pages (from-to)360-369
Number of pages10
JournalBlood advances
Volume3
Issue number3
DOIs
Publication statusPublished - Feb 12 2019

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Dreger, P., Sureda, A., Ahn, K. W., Eapen, M., Litovich, C., Finel, H., Boumendil, A., Gopal, A., Herrera, A. F., Schmid, C., Diez-Martin, J. L., Fuchs, E., Bolaños-Meade, J., Gooptu, M., Al Malki, M. M., Castagna, L., Ciurea, S. O., Dominietto, A., Blaise, D., ... Hamadani, M. (2019). PTCy-based haploidentical vs matched related or unrelated donor reduced-intensity conditioning transplant for DLBCL. Blood advances, 3(3), 360-369. https://doi.org/10.1182/bloodadvances.2018027748