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T-cell-replete HLA-haploidentical hematopoietic transplantation for hematologic malignancies using post-transplantation cyclophosphamide results in outcomes equivalent to those of contemporaneous HLA-matched related and unrelated donor transplantation.
J Clin Oncol. 2013 Apr 01; 31(10):1310-6.JC

Abstract

PURPOSE

T-cell-replete grafts from haploidentical donors using post-transplantation cyclophosphamide may represent a solution for patients who require allogeneic hematopoietic cell transplantation (alloHCT) but lack a conventional donor. We compared outcomes of alloHCT using haploidentical donors with those of transplantation using conventional HLA-matched sibling donors (MRDs) and HLA-matched unrelated donors (MUDs).

PATIENTS AND METHODS

Outcomes of 271 consecutive patients undergoing T-cell-replete first alloHCT for hematologic malignancies performed contemporaneously at a single center (53 using haploidentical donors; 117, MRDs; 101, MUDs) were compared. Overall and disease-free survival (DFS) were adjusted for effects of significant patient-, disease-, and transplantation-related covariates using a stratified Cox model.

RESULTS

Patient characteristics were similar between the three donor groups. For patients undergoing MRD, MUD, and haploidentical transplantation, 24-month cumulative incidences of nonrelapse mortality were 13%, 16%, and 7% and of relapse were 34%, 34%, and 33%, respectively (P not significant [NS]). Cumulative incidences of grades 3 to 4 acute graft-versus-host disease (GVHD) at 6 months were 8%, 11%, and 11%, respectively (P NS); extensive chronic GVHD occurred in 54%, 54%, and 38% of patients, respectively (P < .05 for those undergoing haploidentical donor v MRD or MUD transplantation). Adjusted 24-month probabilities of survival were 76%, 67%, and 64% and of DFS were 53%, 52%, and 60%, respectively; these were not significantly different among the three donor groups.

CONCLUSION

Haploidentical transplantation performed using T-cell-replete grafts and post-transplantation cyclophosphamide achieves outcomes equivalent to those of contemporaneous transplantation performed using MRDs and MUDs. Such transplantation represents a valid alternative for patients who lack a conventional donor.

Authors+Show Affiliations

Northside Hospital, Atlanta, GA 30342, USA. abashey@bmtga.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23423745

Citation

Bashey, Asad, et al. "T-cell-replete HLA-haploidentical Hematopoietic Transplantation for Hematologic Malignancies Using Post-transplantation Cyclophosphamide Results in Outcomes Equivalent to Those of Contemporaneous HLA-matched Related and Unrelated Donor Transplantation." Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, vol. 31, no. 10, 2013, pp. 1310-6.
Bashey A, Zhang X, Sizemore CA, et al. T-cell-replete HLA-haploidentical hematopoietic transplantation for hematologic malignancies using post-transplantation cyclophosphamide results in outcomes equivalent to those of contemporaneous HLA-matched related and unrelated donor transplantation. J Clin Oncol. 2013;31(10):1310-6.
Bashey, A., Zhang, X., Sizemore, C. A., Manion, K., Brown, S., Holland, H. K., Morris, L. E., & Solomon, S. R. (2013). T-cell-replete HLA-haploidentical hematopoietic transplantation for hematologic malignancies using post-transplantation cyclophosphamide results in outcomes equivalent to those of contemporaneous HLA-matched related and unrelated donor transplantation. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, 31(10), 1310-6. https://doi.org/10.1200/JCO.2012.44.3523
Bashey A, et al. T-cell-replete HLA-haploidentical Hematopoietic Transplantation for Hematologic Malignancies Using Post-transplantation Cyclophosphamide Results in Outcomes Equivalent to Those of Contemporaneous HLA-matched Related and Unrelated Donor Transplantation. J Clin Oncol. 2013 Apr 1;31(10):1310-6. PubMed PMID: 23423745.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - T-cell-replete HLA-haploidentical hematopoietic transplantation for hematologic malignancies using post-transplantation cyclophosphamide results in outcomes equivalent to those of contemporaneous HLA-matched related and unrelated donor transplantation. AU - Bashey,Asad, AU - Zhang,Xu, AU - Sizemore,Connie A, AU - Manion,Karen, AU - Brown,Stacey, AU - Holland,H Kent, AU - Morris,Lawrence E, AU - Solomon,Scott R, Y1 - 2013/02/19/ PY - 2013/2/21/entrez PY - 2013/2/21/pubmed PY - 2013/5/25/medline SP - 1310 EP - 6 JF - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JO - J. Clin. Oncol. VL - 31 IS - 10 N2 - PURPOSE: T-cell-replete grafts from haploidentical donors using post-transplantation cyclophosphamide may represent a solution for patients who require allogeneic hematopoietic cell transplantation (alloHCT) but lack a conventional donor. We compared outcomes of alloHCT using haploidentical donors with those of transplantation using conventional HLA-matched sibling donors (MRDs) and HLA-matched unrelated donors (MUDs). PATIENTS AND METHODS: Outcomes of 271 consecutive patients undergoing T-cell-replete first alloHCT for hematologic malignancies performed contemporaneously at a single center (53 using haploidentical donors; 117, MRDs; 101, MUDs) were compared. Overall and disease-free survival (DFS) were adjusted for effects of significant patient-, disease-, and transplantation-related covariates using a stratified Cox model. RESULTS: Patient characteristics were similar between the three donor groups. For patients undergoing MRD, MUD, and haploidentical transplantation, 24-month cumulative incidences of nonrelapse mortality were 13%, 16%, and 7% and of relapse were 34%, 34%, and 33%, respectively (P not significant [NS]). Cumulative incidences of grades 3 to 4 acute graft-versus-host disease (GVHD) at 6 months were 8%, 11%, and 11%, respectively (P NS); extensive chronic GVHD occurred in 54%, 54%, and 38% of patients, respectively (P < .05 for those undergoing haploidentical donor v MRD or MUD transplantation). Adjusted 24-month probabilities of survival were 76%, 67%, and 64% and of DFS were 53%, 52%, and 60%, respectively; these were not significantly different among the three donor groups. CONCLUSION: Haploidentical transplantation performed using T-cell-replete grafts and post-transplantation cyclophosphamide achieves outcomes equivalent to those of contemporaneous transplantation performed using MRDs and MUDs. Such transplantation represents a valid alternative for patients who lack a conventional donor. SN - 1527-7755 UR - https://www.unboundmedicine.com/medline/citation/23423745/T_cell_replete_HLA_haploidentical_hematopoietic_transplantation_for_hematologic_malignancies_using_post_transplantation_cyclophosphamide_results_in_outcomes_equivalent_to_those_of_contemporaneous_HLA_matched_related_and_unrelated_donor_transplantation_ L2 - http://ascopubs.org/doi/full/10.1200/JCO.2012.44.3523?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -