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
| Autor: | Xu Zhang, Connie A. Sizemore, Karen Manion, Stacey Brown, Asad Bashey, Lawrence E. Morris, Scott R. Solomon, H. Kent Holland |
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| Rok vydání: | 2013 |
| Předmět: |
Oncology
Male Cancer Research medicine.medical_specialty Cyclophosphamide medicine.medical_treatment T-Lymphocytes Graft vs Host Disease Blood Donors Hematopoietic stem cell transplantation Human leukocyte antigen Single Center Disease-Free Survival Unrelated Donor HLA Antigens Internal medicine Outcome Assessment Health Care medicine Humans Transplantation Homologous Proportional Hazards Models Postoperative Care Proportional hazards model business.industry Siblings Hematopoietic Stem Cell Transplantation Middle Aged Surgery Transplantation Haematopoiesis Hematologic Neoplasms Female business Unrelated Donors Immunosuppressive Agents medicine.drug |
| Zdroj: | Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 31(10) |
| ISSN: | 1527-7755 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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