Haploidentical T Cell–Replete Transplantation with Post-Transplantation Cyclophosphamide for Patients in or above the Sixth Decade of Age Compared with Allogeneic Hematopoietic Stem Cell Transplantation from an Human Leukocyte Antigen–Matched Related or Unrelated Donor

Didier Blaise, Sabine Fürst, Roberto Crocchiolo, Jean El-Cheikh, Angela Granata, Samia Harbi, Reda Bouabdallah, Raynier Devillier, Stephania Bramanti, Claude Lemarie, Christophe Picard, Christian Chabannon (+5 others)
2016 Biology of Blood and Marrow Transplantation  
It has recently been shown that a T cellereplete allogeneic (allo) hematopoietic stem cell transplantation (HSCT) from a haploidentical donor (haplo-ID) could be a valid treatment for hematological malignancies. However, little data exist concerning older populations. We provided transplantation to 31 patients over the age of 55 years from a haplo-ID and compared their outcomes with patients of the same ages who underwent transplantation from a matched related (MRD) or an unrelated donor (UD).
more » ... ll 3 groups were comparable, except for their conditioning. Patients in haplo-ID group received 2 days of post-transplantation high-dose cyclophosphamide followed by cyclosporine A and mycophenolate mofetil, whereas patients in other groups received pretransplantation antithymocyte globulin, cyclosporine A, and additional mycophenolate mofetil in case of 1-antigen mismatch. All patients but 1 in the haplo-ID group engrafted. The incidence of grades 2 to 4 acute graft-versus-host disease (GVHD) was not statistically different between recipients from haplo-ID (cumulative incidence, 23%) and MRD (cumulative incidence, 21%) transplantations but it was lower than after UD HSCT (cumulative incidence, 44%). No patient in the haplo-ID group developed severe chronic GVHD, compared with cumulative incidences of 16% and 14% after MRD (P ¼ .02) and UD (P ¼ .03) grafts, respectively. The cumulative incidences of relapse were similar in the 3 groups, whereas nonrelapse mortality after UD HSCT was 3-fold higher than after haplo-ID or MRD HSCT. Overall, 2-year overall survival (70%), progressionfree survival (67%), and progression and severe chronic GVHDefree survival (67%) probabilities after haplo-ID did not statistically differ from MRD transplantation (78%, 64%, and 51%, respectively), although they were higher than after UD transplantation (51% [P ¼ .08], 38% [P ¼ .02], and 31% [P ¼ .007]). We conclude that T cellereplete haplo-ID HSCT followed by post-transplantation high-dose-cyclophosphamide in patients over 55 years is associated with promising results, similar to MRD HSCT, and is deserving prospective evaluation. Ó
doi:10.1016/j.bbmt.2015.08.029 pmid:26341397 fatcat:jnyrcqbzlngztmq4t3chpwm234