Composite GRFS and CRFS Outcomes After Adult Alternative Donor HCT.
Publication/Presentation Date
6-20-2020
Abstract
PURPOSE: There is no consensus on the best choice of an alternative donor (umbilical cord blood [UCB], haploidentical, one-antigen mismatched [7/8]-bone marrow [BM], or 7/8-peripheral blood [PB]) for hematopoietic cell transplantation (HCT) for patients lacking an HLA-matched related or unrelated donor.
METHODS: We report composite end points of graft-versus-host disease (GVHD)-free relapse-free survival (GRFS) and chronic GVHD (cGVHD)-free relapse-free survival (CRFS) in 2,198 patients who underwent UCB (n = 838), haploidentical (n = 159), 7/8-BM (n = 241), or 7/8-PB (n = 960) HCT. All groups were divided by myeloablative conditioning (MAC) intensity or reduced intensity conditioning (RIC), except haploidentical group in which most received RIC. To account for multiple testing,
RESULTS: In multivariable analysis, haploidentical group had the best GRFS, CRFS, and overall survival (OS). In the direct pairwise comparison of other groups, among those who received MAC, there was no difference in GRFS or CRFS among UCB, 7/8-BM, and 7/8-PB with serotherapy (alemtuzumab or antithymocyte globulin) groups. In contrast, the 7/8-PB without serotherapy group had significantly inferior GRFS, higher cGVHD, and a trend toward worse CRFS (hazard ratio [HR], 1.38; 95% CI, 1.13 to 1.69;
CONCLUSION: Recognizing the limitations of a registry retrospective analysis and the possibility of center selection bias in choosing donors, our data support the use of UCB, 7/8-BM, or 7/8-PB (with serotherapy) grafts for patients undergoing MAC HCT and haploidentical grafts for patients undergoing RIC HCT. The haploidentical group had the best GRFS, CRFS, and OS of all groups.
Volume
38
Issue
18
First Page
2062
Last Page
2076
ISSN
1527-7755
Published In/Presented At
Mehta, R. S., Holtan, S. G., Wang, T., Hemmer, M. T., Spellman, S. R., Arora, M., Couriel, D. R., Alousi, A. M., Pidala, J., Abdel-Azim, H., Agrawal, V., Ahmed, I., Al-Homsi, A. S., Aljurf, M., Antin, J. H., Askar, M., Auletta, J. J., Bhatt, V. R., Chee, L., Chhabra, S., … Weisdorf, D. J. (2020). Composite GRFS and CRFS Outcomes After Adult Alternative Donor HCT. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 38(18), 2062–2076. https://doi.org/10.1200/JCO.19.00396
Disciplines
Medicine and Health Sciences
PubMedID
32364845
Department(s)
Department of Medicine, Lehigh Valley Topper Cancer Institute
Document Type
Article