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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

Data supplements

Article Figures & Data

Figures

Tables

  • Table 1.

    Patient characteristics

    Haplo donorMSDMUD TCD+MUD TCD−P
    Number of patients132525403378
    Number of centers24864551
    Reporting registry<.001
     CIBMTR97 (73)353 (67)166 (41)263 (70)
     EBMT35 (27)172 (33)237 (59)115 (30)
    Patient age, median (range), y58 (20-75)55 (19-73)55 (19-75)56 (23-73)<.001
    Patients ≥60 y59 (45)135 (26)121 (30)134 (35)
    Male sex86 (65)323 (62)259 (64)218 (58).22
    KPS ≥9096 (73)325 (62)249 (62)216 (57).003
    KPS missing5 (4)24 (4)26 (6)10 (2)
    HCT-CI<.001
     033 (25)119 (23)54 (13)63 (17)
     1-231 (23)112 (21)75 (19)84 (22)
     ≥336 (27)137 (26)85 (21)125 (33)
     Missing*33 (25)157 (30)189 (47)106 (28)
    Patient race<.001
     White91 (69)349 (66)258 (64)282 (75)
     African American15 (11)12 (2)2 (<1)5 (1)
     Other2 (2)36 (8)2 (<1)7 (1)
     Missing24 (18)128 (24)141 (36)84 (22)
    Time from diagnosis to transplant, median (range), mo22 (<1-173)26 (2-386)24 (2-340)28 (2-299).18
    Previous auto-HCT56 (42)288 (55)237 (59)229 (61).002
    Remission status at HCT.72
     Complete63 (48)217 (41)179 (44)171 (45)
     Partial45 (34)181 (34)133 (33)133 (35)
     Refractory23 (17)109 (21)74 (18)64 (17)
     Untreated/unknown1 (<1)18 (4)17 (5)10 (3)
    TBI in conditioning114 (86)109 (21)30 (7)121 (32)<.001
    Graft type<.001
     Bone marrow100 (76)10 (2)30 (7)20 (5)
     Peripheral blood32 (24)515 (98)373 (93)358 (95)
    CMV status
     D+/R−11 (8)38 (7)21 (5)31 (8)<.001
     Missing64 (49)257 (49)240 (58)120 (31)
    D-R sex match<.001
     Female-male42 (32)139 (26)95 (24)66 (17)
     Other90 (68)386 (74)306 (75)311 (82)
     Missing02 (<1)2 (<1)1 (<1)
    GVHD prophylaxis<.001
     PTCy132N/AN/AN/A
     CNI + MMF ± othersN/A191 (36)158 (39)159 (42)
     CNI + MTX ± othersN/A236 (45)154 (38)150 (40)
     CNI + othersN/A98 (19)91 (23)69 (18)
    Follow-up of survivors, median (range), mo49 (12-73)48 (2-97)49 (3-100)39 (4-96)
    • Values in parentheses represent percentages if not indicated otherwise.

    • A/C, anti–thymocyte globulin/alemtuzumab; CMV, cytomegalovirus; D-R, donor-recipient; HCT-CI, hematopoietic cell transplant-comorbidity index; KPS, Karnofsky performance score; MMF, mycophenolate mofetil; MTX, methotrexate; N/A, not applicable; w, with; w/o, without.

    • * EBMT does not collect this variable for minimal essential data (MED-A) patients.

    • Details of conditioning regimens are given in supplemental Table 2.

  • Table 2.

    Univariate outcomes

    OutcomesHaploidentical donor (n = 132)MSD (n = 525)MUD TCD+ (n = 403)MUD TCD− (n = 378)
    EvalProb (95% CI), %EvalProb (95% CI), %EvalProb (95% CI), %EvalProb (95% CI), %P
    Neutrophil recovery126475383336.004
     28 d90 (84-94)97 (95-98)*95 (93-97)96 (93-98).10
     100 d99 (97-100)99 (98-100)98 (97-99)99 (98-100).79
    Platelet recovery82342276238<.001
     28 d61 (50-71)92 (89-95)*89 (85-92)*89 (84-92)*<.001
     100 d91 (84-96)99 (97-100)*96 (93-98)98 (96-99).01
    Acute GVHD 2-4123490377359.001
     180 d34 (26-43)32 (28-36)32 (28-38)42 (37-47).01
    Acute GVHD 3-4123456377359<.001
     180 d7 (3-12)11 (9-14)13 (10-16)19 (15-23)*<.001
    Chronic GVHD124522403335<.001
     1 y15 (9-21)41 (37-46)*23 (19-28)48 (42-53)*<.001
     2 y18 (12-26)48 (43-52)*27 (23-32)57 (52-63)*<.001
    NRM132525403378.001
     1 y16 (10-23)13 (10-16)21 (17-26)20 (16-24).007
     3 y22 (15-30)17 (13-20)26 (21-31)30 (25-35)<.001
    Relapse/progression132525403378<.001
     1 y34 (26-43)39 (34-43)33 (28-38)28 (23-33).01
     3 y41 (32-49)47 (42-51)38 (33-43)34 (29-39).001
    PFS132525403378.72
     1 y50 (41-58)48 (44-53)%46 (40-51)52 (47-57).32
     3 y38 (29-47)37 (32-41)36 (31-41)37 (31-42).99
    OS132525403378.36
     1 y66 (58-74)65 (61-69)56 (51-61)63 (58-68).03
     3 y46 (37-55)50 (45-55)43 (38-49)46 (41-52).32
    • Eval, number of evaluable patients; Prob, probability; TCD+, TCD with alemtuzumab or anti–thymocyte globulin; TCD−, TCD without alemtuzumab or anti–thymocyte globulin.

    • * Significant pairwise comparisons in reference to the haploidentical donor group.

  • Table 3.

    Multivariate analysis

    nOR or RR*Lower CLUpper CLPOverall P
    Acute grade 2-4 GVHD
     Haploidentical donors1231.009
     MSD4930.880.581.33.54
     MUD TCD+3770.920.601.41.70
     MUD TCD−3591.390.902.13.13
    Acute grade 3-4 GVHD
     Haploidentical donors1231.0007
     MSD4931.560.753.26.24
     MUD TCD+3771.840.883.89.11
     MUD TCD−3593.051.476.32.0028
    Chronic GVHD
     Haploidentical donors1271<.0001
     MSD4693.152.084.77<.0001
     MUD TCD+3212.051.323.17.001
     MUD TCD−3444.062.686.15<.0001
    NRM
     Haploidentical donors1321.08
     MSD5220.900.601.360.62
     MUD TCD+4031.170.771.760.46
     MUD TCD−3781.280.861.910.23
    Significant contrast
     MSD vs MUD TCD−0.710.540.93.01
    Relapse/progression
     Haploidentical donors1321.009
     MSD5251.060.791.41.71
     MUD TCD+4030.920.681.25.60
     MUD TCD−3780.730.531.00.05
    Significant contrast
     MSD vs MUD TCD−1.451.171.80.0008
    PFS
     Haploidentical donors1321.45
     MSD5220.940.741.19.61
     MUD TCD+4030.970.761.24.84
     MUD TCD−3780.860.671.09.21
    OS
     Haploidentical donors1321.52
     MSD5220.900.691.16.42
     MUD TCD+4031.020.781.33.90
     MUD TCD−3780.910.701.19.49
    • The main effect of multivariate analysis is shown. Complete multivariate analysis results are provided in supplemental Table 3.

    • CL, confidence limit.

    • * Values are odds ratios (ORs) for “Acute grade 2-4 GVHD” and “Acute grade 3-4 GVHD”; all others are RR.