Haplo-identical allografting with post-transplant cyclophosphamide in high-risk patients.

Abstract:

:Haplo-identical transplants (Haplo-Tx) are an important alternative for patients with hematological malignancies who lack a HLA-identical donor. Seventy-one T-replete Haplo-Tx were performed in 70 high-risk patients at our center; 22/70 (31%) patients with refractory/relapsed leukemia received sequential salvage therapy (SeqTh) with high-dose chemotherapy followed by Haplo-Tx during the chemotherapy-induced neutropenia. Graft-versus-host disease (GVHD) prophylaxis consisted of post-transplant cyclophosphamide (days + 3 and + 4) with tacrolimus and mycophenolic acid. After a median follow-up of 29.2 months, 3-year overall survival (OS) and event-free survival (EFS) were 43.8 and 40.2%, while 3-year cumulative incidences (CIs) of non-relapse mortality (NRM) and relapse (RI) were 27 and 33%. Day 100 and day 400 CI of grade III-IV acute and moderate-severe chronic GVHD were 11 and 15%. Three-year RI was significantly lower in patients in complete remission (CR) versus those not in CR at the time of transplant (21.5 vs. 48%, p = 0.009) and in patients who received PBSC as compared to BM (22 vs. 45%, p = 0.009). In patients treated with SeqTh, 3-year OS was 19%, while 3-year RI and NRM were 52 and 28% at a median follow-up of 50 months. Overall, Haplo-Tx was feasible in heavily pretreated high-risk patients without a suitable HLA-identical donor.

journal_name

Ann Hematol

journal_title

Annals of hematology

authors

Brunello L,Passera R,Dellacasa CM,Giaccone L,Audisio E,Ferrero D,D'Ardia S,Allione B,Aydin S,Festuccia M,Lia G,Crisà E,Maffini E,Butera S,Busca A,Bruno B

doi

10.1007/s00277-018-3433-3

subject

Has Abstract

pub_date

2018-11-01 00:00:00

pages

2205-2215

issue

11

eissn

0939-5555

issn

1432-0584

pii

10.1007/s00277-018-3433-3

journal_volume

97

pub_type

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