Haploidentical T Cell-Replete Transplantation with Post-Transplantation Cyclophosphamide for Patients in or above the Sixth Decade of Age Compared with Allogeneic Hematopoietic Stem Cell Transplantation from an Human Leukocyte Antigen-Matched Related or Unrelated Donor.
It has recently been shown that a T cell-replete allogeneic (allo) hematopoietic stem cell transplantation (HSCT) from a haploidentical donor (haplo-ID) could be a valid treatment for hematological malignancies. However, little data exist concerning older populations. We provided transplantation to 31 patients over the age of 55 years from a haplo-ID and compared their outcomes with patients of the same ages who underwent transplantation from a matched related (MRD) or an unrelated donor (UD). All 3 groups were comparable, except for their conditioning. Patients in haplo-ID group received 2 days of post-transplantation high-dose cyclophosphamide followed by cyclosporine A and mycophenolate mofetil, whereas patients in other groups received pretransplantation antithymocyte globulin, cyclosporine A, and additional mycophenolate mofetil in case of 1-antigen mismatch. All patients but 1 in the haplo-ID group engrafted. The incidence of grades 2 to 4 acute graft-versus-host disease (GVHD) was not statistically different between recipients from haplo-ID (cumulative incidence, 23%) and MRD (cumulative incidence, 21%) transplantations but it was lower than after UD HSCT (cumulative incidence, 44%). No patient in the haplo-ID group developed severe chronic GVHD, compared with cumulative incidences of 16% and 14% after MRD (P = .02) and UD (P = .03) grafts, respectively. The cumulative incidences of relapse were similar in the 3 groups, whereas nonrelapse mortality after UD HSCT was 3-fold higher than after haplo-ID or MRD HSCT. Overall, 2-year overall survival (70%), progression-free survival (67%), and progression and severe chronic GVHD-free survival (67%) probabilities after haplo-ID did not statistically differ from MRD transplantation (78%, 64%, and 51%, respectively), although they were higher than after UD transplantation (51% [P = .08], 38% [P = .02], and 31% [P = .007]). We conclude that T cell-replete haplo-ID HSCT followed by post-transplantation high-dose- cyclophosphamide in patients over 55 years is associated with promising results, similar to MRD HSCT, and is deserving prospective evaluation.
Transplant and Cellular Therapy Unit, Institut Paoli Calmettes, Marseille, France; Hematology Department, Institut Paoli Calmettes, Marseille, France; Centre de Recherche en Cancérologie de Marseille (CRCM), Marseille, France; Aix-Marseille University (AMU), Marseille, France. Electronic address: blaised@ipc.unicancer.fr.
Didier
D
Blaise
Transplant and Cellular Therapy Unit, Institut Paoli Calmettes, Marseille, France; Hematology Department, Institut Paoli Calmettes, Marseille, France.
Sabine
S
Fürst
Transplant unit, Department of Hemato-oncology, Humanitas Cancer Center, Milano, Italy.
Roberto
R
Crocchiolo
Transplant and Cellular Therapy Unit, Institut Paoli Calmettes, Marseille, France; Hematology Department, Institut Paoli Calmettes, Marseille, France.
Jean
J
El-Cheikh
Transplant and Cellular Therapy Unit, Institut Paoli Calmettes, Marseille, France; Hematology Department, Institut Paoli Calmettes, Marseille, France.
Angela
A
Granata
Transplant and Cellular Therapy Unit, Institut Paoli Calmettes, Marseille, France; Hematology Department, Institut Paoli Calmettes, Marseille, France.
Samia
S
Harbi
Hematology Department, Institut Paoli Calmettes, Marseille, France.
Reda
R
Bouabdallah
Transplant and Cellular Therapy Unit, Institut Paoli Calmettes, Marseille, France; Hematology Department, Institut Paoli Calmettes, Marseille, France.
Raynier
R
Devillier
Transplant unit, Department of Hemato-oncology, Humanitas Cancer Center, Milano, Italy.
Stephania
S
Bramanti
Cell Therapy Facility, Institut Paoli Calmettes, Marseille, France.
Claude
C
Lemarie
HLA immunogenetic Laboratory, Blood Bank, Marseille, France.
Christophe
C
Picard
Centre de Recherche en Cancérologie de Marseille (CRCM), Marseille, France; Aix-Marseille University (AMU), Marseille, France; Cell Therapy Facility, Institut Paoli Calmettes, Marseille, France; Inserm CBT-510, Clinical Investigation Center in Biotherapy, Institut Paoli Calmettes, Marseille, France.
Christian
C
Chabannon
Transplant and Cellular Therapy Unit, Institut Paoli Calmettes, Marseille, France; Hematology Department, Institut Paoli Calmettes, Marseille, France; Aix-Marseille University (AMU), Marseille, France.
Pierre-Jean
PJ
Weiller
Transplant and Cellular Therapy Unit, Institut Paoli Calmettes, Marseille, France; Hematology Department, Institut Paoli Calmettes, Marseille, France.
Catherine
C
Faucher
Transplant and Cellular Therapy Unit, Institut Paoli Calmettes, Marseille, France; Hematology Department, Institut Paoli Calmettes, Marseille, France.
Bilal
B
Mohty
Hematology Department, Institut Paoli Calmettes, Marseille, France; Centre de Recherche en Cancérologie de Marseille (CRCM), Marseille, France; Aix-Marseille University (AMU), Marseille, France.
Norbert
N
Vey
Transplant and Cellular Therapy Unit, Institut Paoli Calmettes, Marseille, France; Hematology Department, Institut Paoli Calmettes, Marseille, France; Transplant unit, Department of Hemato-oncology, Humanitas Cancer Center, Milano, Italy.
Luca
L
Castagna
D000368:Aged; D064591:Allografts; D003520:Cyclophosphamide / Q000008:administration & dosage*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D013601:T-Lymphocytes / Q000637:transplantation*; D061349:Unrelated Donors
D003520:Cyclophosphamide
Allogeneic; Elderly; Haplo-identical; Related donor; Unrelated donor