Anti-thymocyte Globulin and Post-Transplant Cyclophosphamide do not abrogate the inferior outcome risk conferred by human leukocyte antigen-A and -B mismatched donors.
Igor Novitzky-BassoMats RembergerCarol ChenCynthia EllisonIvan PasicWilson LamArjun LawArmin GerbitzAuro ViswabandyaJeffrey Howard LiptonDennis Dong Hwan KimRajat KumarFotios V MichelisJonas MattssonPublished in: European journal of haematology (2021)
In donor selection for allogeneic stem cell transplant, several factors are considered for potential impact on transplant outcome. Previous publications suggested single HLA-mismatched unrelated donors (MMUD) may be equivalent to 10/10 matched unrelated donors (MUDs). We retrospectively examined factors affecting outcome in a single-center study using ATG followed by post-transplant cyclophosphamide, termed ATG-PTCy, GvHD prophylaxis. Fifty-two patients who received grafts from MMUD and 188 patients transplanted from MUD between January 2015 and December 2019, at Princess Margaret Cancer Centre, Canada, were enrolled. All patients received reduced-intensity conditioning. Overall survival for 9/10 recipients at 2 years was significantly worse, 37.2% versus 68.5% for 10/10 MUDs, p < .001, as were NRM at 1 year 39.5% versus 11.7%, p < .001, and GRFS at 2 years 29.8% versus 58.8%, p < .001, respectively, potentially due to higher incidence of infections including CMV. By multivariable analysis, factors correlating with survival negatively were DRI, and MMUD, whereas for NRM MMUD and increasing age were unfavorable. For GRFS significant unfavorable factors included donor age ≤32 years, female donor to male recipient, DRI high-very high and MMUD. These data suggest that MMUD, primarily HLA-A and HLA-B MMUD, confer significantly inferior outcome despite use of ATG-PTCy. Further development of novel conditioning regimens and GvHD prophylaxis is needed to mitigate these risks.
Keyphrases
- end stage renal disease
- stem cells
- ejection fraction
- newly diagnosed
- chronic kidney disease
- prognostic factors
- low dose
- bone marrow
- risk assessment
- squamous cell carcinoma
- big data
- cord blood
- mesenchymal stem cells
- electronic health record
- artificial intelligence
- peripheral blood
- lymph node metastasis
- pluripotent stem cells