Risk Factors for Graft-versus-Host Disease in Haploidentical Hematopoietic Cell Transplantation Using Post-Transplant Cyclophosphamide.
Annie ImArmin RashidiTao WangMichael HemmerMargaret L MacMillanJoseph PidalaMadan JagasiaSteven PavleticNavneet S MajhailDaniel WeisdorfHisham Abdel-AzimVaibhav AgrawalA Samer Al-HomsiMahmoud AljurfMedhat AskarJeffery J AulettaAsad BasheyAmer BeitinjanehVijaya Raj BhattMichael ByrneJean-Yves CahnMitchell CairoPaul CastilloJan CernySaurabh ChhabraHannah ChoeStefan CiureaAndrew DalyMiguel Angel Diaz PerezNosha FarhadfarShahinaz M GadallaRobert GaleSiddhartha GangulyUsama GergisRabi HannaPeiman HemattiRoger HerzigGerhard C HildebrandtDeepesh P LadCatherine LeeLeslie LehmannLazaros LekakisRammurti T KambleMohamed A Kharfan-DabajaPooja KhandelwalRodrigo MartinoHemant S MurthyTaiga NishihoriTracey A O'BrienRichard F OlssonSagar S PatelMiguel-Angel PeralesTim PrestidgeMuna QayedRizwan RomeeHélène SchoemansSachiko SeoAkshay SharmaMelhem SolhRoger StrairTakanori TeshimaAlvaro Urbano-IspizuaMarjolein Van der PoelRavi VijJohn L WagnerBasem WilliamBaldeep WirkJean A YaredSteve R SpellmanMukta AroraBetty K HamiltonPublished in: Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation (2020)
Post-transplant cyclophosphamide (PTCy) has significantly increased the successful use of haploidentical donors with a relatively low incidence of graft-versus-host disease (GVHD). Given its increasing use, we sought to determine risk factors for GVHD after haploidentical hematopoietic cell transplantation (haplo-HCT) using PTCy. Data from the Center for International Blood and Marrow Transplant Research on adult patients with acute myeloid leukemia, acute lymphoblastic leukemia, myelodysplastic syndrome, or chronic myeloid leukemia who underwent PTCy-based haplo-HCT (2013 to 2016) were analyzed and categorized into 4 groups based on myeloablative (MA) or reduced-intensity conditioning (RIC) and bone marrow (BM) or peripheral blood (PB) graft source. In total, 646 patients were identified (MA-BM = 79, MA-PB = 183, RIC-BM = 192, RIC-PB = 192). The incidence of grade 2 to 4 acute GVHD at 6 months was highest in MA-PB (44%), followed by RIC-PB (36%), MA-BM (36%), and RIC-BM (30%) (P = .002). The incidence of chronic GVHD at 1 year was 40%, 34%, 24%, and 20%, respectively (P < .001). In multivariable analysis, there was no impact of stem cell source or conditioning regimen on grade 2 to 4 acute GVHD; however, older donor age (30 to 49 versus <29 years) was significantly associated with higher rates of grade 2 to 4 acute GVHD (hazard ratio [HR], 1.53; 95% confidence interval [CI], 1.11 to 2.12; P = .01). In contrast, PB compared to BM as a stem cell source was a significant risk factor for the development of chronic GVHD (HR, 1.70; 95% CI, 1.11 to 2.62; P = .01) in the RIC setting. There were no differences in relapse or overall survival between groups. Donor age and graft source are risk factors for acute and chronic GVHD, respectively, after PTCy-based haplo-HCT. Our results indicate that in RIC haplo-HCT, the risk of chronic GVHD is higher with PB stem cells, without any difference in relapse or overall survival.
Keyphrases
- allogeneic hematopoietic stem cell transplantation
- stem cells
- acute lymphoblastic leukemia
- acute myeloid leukemia
- heavy metals
- bone marrow
- peripheral blood
- liver failure
- drug induced
- stem cell transplantation
- respiratory failure
- aqueous solution
- risk factors
- high dose
- free survival
- low dose
- mesenchymal stem cells
- end stage renal disease
- intensive care unit
- ejection fraction
- physical activity
- electronic health record
- cell cycle arrest
- newly diagnosed
- chronic myeloid leukemia
- magnetic resonance
- chronic kidney disease
- magnetic resonance imaging
- signaling pathway
- computed tomography
- big data
- cell therapy
- extracorporeal membrane oxygenation
- peritoneal dialysis
- middle aged
- cell proliferation
- patient reported