title: Unmanipulated haploidentical transplants compared with other alternative donors and matched sibling grafts.
abstract: We studied 459 consecutive patients with hematologic malignancies, median age 44 years (range, 15 to 71 years), who underwent transplantation with grafts from identical sibling donors (SIB; n = 176), matched unrelated donors (MUD; n = 43), mismatched unrelated donors (mmUD; n = 43), unrelated cord blood (UCB; n = 105) or HLA-haploidentical family donors (HAPLO; n = 92). Graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporine and methotrexate in the SIB recipients; antithymocyte globulin for the MUD, mmUD, and UCB recipients; and post-transplantation cyclophosphamide, cyclosporine, and mycophenolate in the HAPLO recipients. Conditioning regimens were mostly myeloablative (69%). Advanced disease phase was more frequent, but not significantly so, in the HAPLO and mmUD groups (P = .08). Acute GVHD grade II-IV was significantly less frequent in the HAPLO, UCB, and MUD groups (14% to 21%) compared with the SIB (31%) and mmUD (42%) groups (P < .001), and there was a trend toward less moderate-severe chronic GVHD in the HAPLO and UCB groups (P = .053). The proportion of patients off cyclosporine at 1 year ranged from 55% for the SIB group to 81% for the HAPLO group (P < .001). Transplantation-related mortality at 2 years was lower in the HAPLO and SIB groups (18% to 24%) compared with the MUD, mmUD, and UCB groups (33% to 35%; P = .10). Relapse rate was comparable in the 5 groups (P = .80). The 4-year actuarial survival was 45% in the SIB group, 43% in the MUD group, 40% in the mmUD group, 34% in the UCB group, and 52% in the HAPLO group (P = .10). In multivariate analysis, advanced disease was a negative predictor of survival (hazard ratio [HR], 2.4; P < .0001), together with a diagnosis of acute leukemia (HR, 1.8; P = .0001); HAPLO grafts were comparable to SIB (P = .80), whereas UCB had inferior survival (P = .03). In conclusion, unmanipulated haploidentical family donor transplants are an additional option for patients lacking a matched sibling donor.
authors.affiliation: Division of Hematology and Marrow Transplantation, Istituto Ricerca Carattere Scientifico (IRCCS), San Martino Istituto Tumori (IST), Genova, Italy.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Raiola
authors.affiliation: Division of Hematology and Marrow Transplantation, Istituto Ricerca Carattere Scientifico (IRCCS), San Martino Istituto Tumori (IST), Genova, Italy.
authors.forename: Alida
authors.initials: A
authors.lastname: Dominietto
authors.affiliation: Division of Hematology and Marrow Transplantation, Istituto Ricerca Carattere Scientifico (IRCCS), San Martino Istituto Tumori (IST), Genova, Italy.
authors.forename: Carmen
authors.initials: C
authors.lastname: di Grazia
authors.affiliation: Division of Hematology and Marrow Transplantation, Istituto Ricerca Carattere Scientifico (IRCCS), San Martino Istituto Tumori (IST), Genova, Italy.
authors.forename: Teresa
authors.initials: T
authors.lastname: Lamparelli
authors.affiliation: Division of Hematology and Marrow Transplantation, Istituto Ricerca Carattere Scientifico (IRCCS), San Martino Istituto Tumori (IST), Genova, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Gualandi
authors.affiliation: Division of Hematology and Marrow Transplantation, Istituto Ricerca Carattere Scientifico (IRCCS), San Martino Istituto Tumori (IST), Genova, Italy.
authors.forename: Adalberto
authors.initials: A
authors.lastname: Ibatici
authors.affiliation: Division of Hematology and Marrow Transplantation, Istituto Ricerca Carattere Scientifico (IRCCS), San Martino Istituto Tumori (IST), Genova, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Bregante
authors.affiliation: Division of Hematology and Marrow Transplantation, Istituto Ricerca Carattere Scientifico (IRCCS), San Martino Istituto Tumori (IST), Genova, Italy.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Van Lint
authors.affiliation: Division of Hematology and Marrow Transplantation, Istituto Ricerca Carattere Scientifico (IRCCS), San Martino Istituto Tumori (IST), Genova, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Varaldo
authors.affiliation: Division of Hematology and Marrow Transplantation, Istituto Ricerca Carattere Scientifico (IRCCS), San Martino Istituto Tumori (IST), Genova, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Ghiso
authors.affiliation: Chair of Hematology, University of Genova, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Gobbi
authors.affiliation: Division of Clinical Hematology, IRCCS San Martino IST, Genova, Italy.
authors.forename: Angelo Michele
authors.initials: AM
authors.lastname: Carella
authors.affiliation: Chair of Medical Statistics, University of Genova, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Signori
authors.affiliation: Division of Hematology and Marrow Transplantation, Istituto Ricerca Carattere Scientifico (IRCCS), San Martino Istituto Tumori (IST), Genova, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Galaverna
authors.affiliation: Division of Hematology and Marrow Transplantation, Istituto Ricerca Carattere Scientifico (IRCCS), San Martino Istituto Tumori (IST), Genova, Italy. Electronic address: andrea.bacigalupo@hsanmartino.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Bacigalupo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D036101:Cord Blood Stem Cell Transplantation; D005260:Female; D015870:Gene Expression; D006086:Graft vs Host Disease / Q000517:prevention & control*; D006680:HLA Antigens / Q000235:genetics / Q000276:immunology; D006239:Haplotypes; D019337:Hematologic Neoplasms / Q000235:genetics / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000627:therapeutic use; D011446:Prospective Studies; D012008:Recurrence; D035781:Siblings; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous; D061349:Unrelated Donors
chemical_list: D006680:HLA Antigens; D007166:Immunosuppressive Agents; D019653:Myeloablative Agonists
keywords: Allogeneic transplant; Cord blood; Haploidentical; Unrelated