title: Unmanipulated haploidentical bone marrow transplantation and post-transplant cyclophosphamide for hematologic malignanices following a myeloablative conditioning: an update.
abstract: This is a report of 148 patients with hematologic malignancies who received an unmanipulated haploidentical bone marrow transplant (BMT), followed by post-transplant high-dose cyclophosphamide (PT-CY). All patients received a myeloablative conditioning consisting of thiotepa, busulfan, fludarabine (n=92) or TBI, fludarabine (n=56). The median age was 47 years (17-74); 47 patients were in first remission (CR1), 37 in second remission (CR2) and 64 had an active disease; all patients were first grafts. The diagnosis was acute leukemia (n=75), myelodisplastic syndrome (n=24), myelofibrosis (n=16), high-grade lymphoma (n=15) and others (n=18). GVHD prophylaxis consisted in PT-CY on days +3 and +5, cyclosporine (from day 0), and mycophenolate (from day +1). The median day for neutrophil engraftment was day +18 (13-32). The cumulative incidence of grades II-IV acute GVHD was 24%, and of grades III-IV GVHD 10%. The incidence of moderate-severe chronic GVHD was 12%. With a median follow-up for the surviving patients of 313 days (100-1162), the cumulative incidence of transplant-related mortality (TRM) is 13%, and the relapse-related death is 23%. The actuarial 22 months overall survival is 77% for CR1 patients, 49% for CR2 patients and 38% for patients grafted in relapse (P<0.001). Major causes of death were relapse (22%), GVHD (2%) and infections (6%). We confirm our initial results, suggesting that a myeloablative conditioning regimen followed by unmanipulated haploidentical BMT with PT-CY, results in a low risk of acute and chronic GVHD and encouraging rates of TRM and overall survival, also for patients with active disease at the time of transplant.
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino, Genova, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Bacigalupo
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino, Genova, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Dominietto
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino, Genova, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Ghiso
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino, Genova, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Di Grazia
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino, Genova, Italy.
authors.forename: T
authors.initials: T
authors.lastname: Lamparelli
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino, Genova, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Gualandi
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino, Genova, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Bregante
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino, Genova, Italy.
authors.forename: M T
authors.initials: MT
authors.lastname: Van Lint
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino, Genova, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Geroldi
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino, Genova, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Luchetti
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino, Genova, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Grasso
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino, Genova, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Pozzi
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino, Genova, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Colombo
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino, Genova, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Tedone
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino, Genova, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Varaldo
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino, Genova, Italy.
authors.forename: A M
authors.initials: AM
authors.lastname: Raiola
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D064591:Allografts; D016026:Bone Marrow Transplantation; D003520:Cyclophosphamide / Q000008:administration & dosage*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000187:drug effects*; D006086:Graft vs Host Disease / Q000401:mortality / Q000517:prevention & control; D019337:Hematologic Neoplasms / Q000401:mortality / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D019172:Transplantation Conditioning
chemical_list: D003520:Cyclophosphamide