title: Reduced-intensity transplantation for lymphomas using haploidentical related donors vs HLA-matched unrelated donors.
abstract: We evaluated 917 adult lymphoma patients who received haploidentical (n = 185) or HLA-matched unrelated donor (URD) transplantation either with (n = 241) or without antithymocyte globulin (ATG; n = 491) following reduced-intensity conditioning regimens. Haploidentical recipients received posttransplant cyclophosphamide-based graft-versus-host disease (GVHD) prophylaxis, whereas URD recipients received calcineurin inhibitor-based prophylaxis. Median follow-up of survivors was 3 years. The 100-day cumulative incidence of grade III-IV acute GVHD on univariate analysis was 8%, 12%, and 17% in the haploidentical, URD without ATG, and URD with ATG groups, respectively (P = .44). Corresponding 1-year rates of chronic GVHD on univariate analysis were 13%, 51%, and 33%, respectively (P < .001). On multivariate analysis, grade III-IV acute GVHD was higher in URD without ATG (P = .001), as well as URD with ATG (P = .01), relative to haploidentical transplants. Similarly, relative to haploidentical transplants, risk of chronic GVHD was higher in URD without ATG and URD with ATG (P < .0001). Cumulative incidence of relapse/progression at 3 years was 36%, 28%, and 36% in the haploidentical, URD without ATG, and URD with ATG groups, respectively (P = .07). Corresponding 3-year overall survival (OS) was 60%, 62%, and 50% in the 3 groups, respectively, with multivariate analysis showing no survival difference between URD without ATG (P = .21) or URD with ATG (P = .16), relative to haploidentical transplants. Multivariate analysis showed no difference between the 3 groups in terms of nonrelapse mortality (NRM), relapse/progression, and progression-free survival (PFS). These data suggest that reduced-intensity conditioning haploidentical transplantation with posttransplant cyclophosphamide does not compromise early survival outcomes compared with matched URD transplantation, and is associated with significantly reduced risk of chronic GVHD.
authors.affiliation: Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, WV;
authors.forename: Abraham S
authors.initials: AS
authors.lastname: Kanate
authors.affiliation: S.C. Ematologia e Trapianto di Midollo Osseo, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan, Italy;
authors.forename: Alberto
authors.initials: A
authors.lastname: Mussetti
authors.affiliation: Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL;
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Kharfan-Dabaja
authors.affiliation: Center for International Blood and Marrow Transplant Research, Department of Medicine and Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI;
authors.forename: Kwang W
authors.initials: KW
authors.lastname: Ahn
authors.affiliation: Center for International Blood and Marrow Transplant Research, Department of Medicine and.
authors.forename: Alyssa
authors.initials: A
authors.lastname: DiGilio
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Emily Couric Clinical Cancer Center, Charlottesville, VA;
authors.forename: Amer
authors.initials: A
authors.lastname: Beitinjaneh
authors.affiliation: Division of Hematology/Oncology, Medical University of South Carolina, Charleston, SC;
authors.forename: Saurabh
authors.initials: S
authors.lastname: Chhabra
authors.affiliation: Department of Hematology/Oncology, Froedtert Memorial Lutheran Hospital, Milwaukee, WI;
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Fenske
authors.affiliation: South Texas Veterans Health Care System and University of Texas Health Science Center San Antonio, San Antonio, TX;
authors.forename: Cesar
authors.initials: C
authors.lastname: Freytes
authors.affiliation: Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, United Kingdom;
authors.forename: Robert Peter
authors.initials: RP
authors.lastname: Gale
authors.affiliation: Blood and Marrow Transplantation, Division of Hematology and Oncology, University of Kansas Medical Center, Kansas City, KS;
authors.forename: Siddhartha
authors.initials: S
authors.lastname: Ganguly
authors.affiliation: Department of Haematology, Prince of Wales Hospital, Randwick, NSW, Australia;
authors.forename: Mark
authors.initials: M
authors.lastname: Hertzberg
authors.affiliation: Department for Stem Cell Transplantation, University Cancer Center, Hamburg, Germany;
authors.forename: Evgeny
authors.initials: E
authors.lastname: Klyuchnikov
authors.affiliation: Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH;
authors.forename: Hillard M
authors.initials: HM
authors.lastname: Lazarus
authors.affiliation: Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden;
authors.forename: Richard
authors.initials: R
authors.lastname: Olsson
authors.affiliation: Adult Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY;
authors.forename: Miguel-Angel
authors.initials: MA
authors.lastname: Perales
authors.affiliation: Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, CA;
authors.forename: Andrew
authors.initials: A
authors.lastname: Rezvani
authors.affiliation: Division of Hematology/Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, NC;
authors.forename: Marcie
authors.initials: M
authors.lastname: Riches
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL;
authors.forename: Ayman
authors.initials: A
authors.lastname: Saad
authors.affiliation: The International Center for Cell Therapy & Cancer Immunotherapy, Tel Aviv, Israel;
authors.forename: Shimon
authors.initials: S
authors.lastname: Slavin
authors.affiliation: Section of Hematology/Oncology, The University of Chicago, Chicago, IL;
authors.forename: Sonali M
authors.initials: SM
authors.lastname: Smith
authors.affiliation: Servei d'Hematologia, Institut Catala d'Oncologia, Hospital Duran I Reynals, Barcelona, Spain;
authors.forename: Anna
authors.initials: A
authors.lastname: Sureda
authors.affiliation: Blood & Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Cancer Center, University of Maryland, Baltimore, MD;
authors.forename: Jean
authors.initials: J
authors.lastname: Yared
authors.affiliation: Department of Hematology, MD Anderson Cancer Center, Houston, TX;
authors.forename: Stefan
authors.initials: S
authors.lastname: Ciurea
authors.affiliation: Department of Medical Oncology/Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA;
authors.forename: Philippe
authors.initials: P
authors.lastname: Armand
authors.affiliation: Department of Hematology/Oncology, Fred Hutchinson Cancer Research Center, Seattle, WA; and.
authors.forename: Rachel
authors.initials: R
authors.lastname: Salit
authors.affiliation: Division of Hematologic Malignancies, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD.
authors.forename: Javier
authors.initials: J
authors.lastname: Bolaños-Meade
authors.affiliation: Center for International Blood and Marrow Transplant Research, Department of Medicine and.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Hamadani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D064591:Allografts; D000961:Antilymphocyte Serum / Q000008:administration & dosage*; D002908:Chronic Disease; D003520:Cyclophosphamide / Q000008:administration & dosage*; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000401:mortality / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation; D006650:Histocompatibility Testing; D006801:Humans; D008223:Lymphoma / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D019172:Transplantation Conditioning; D061349:Unrelated Donors
chemical_list: D000961:Antilymphocyte Serum; D003520:Cyclophosphamide