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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 Ciceri, Johanna Tischer, Paolo Corradini, Silvia Montoto, Stephen Robinson, Zafer Gülbas and Mehdi Hamadani

Key Points

  • PTCy-based haplo-HCT provides lower chronic GVHD rates compared with matched sibling or unrelated donor HCT in DLBCL.

  • Three-year OS and PFS after haplo-HCT was 46% and 38%, respectively, in DLBCL.

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.

  • Submitted October 26, 2018.
  • Accepted January 2, 2019.
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