Comparable survival outcomes with haploidentical stem cell transplantation and unrelated bone marrow transplantation.
Yoshiko AtsutaJunichi SugitaHirohisa NakamaeYumiko MaruyamaKen IshiyamaSouichi ShiratoriTakahiro FukudaMio KurataNaoki ShingaiYukiyasu OzawaMasayoshi MasukoKoji NagafujiSatoru TakadaShinichi KakoYoshinobu KandaJunya KandaTatsuo IchinoheTakanori TeshimaPublished in: Bone marrow transplantation (2022)
We retrospectively compared outcomes of unrelated donor bone marrow transplant (UBMT) and HLA-haploidentical peripheral blood stem cell transplantation using post-transplant cyclophosphamide (PTCy-haploPBSCT) using the Japanese registry data. Recipients of first HCT for acute leukemia and myelodysplastic syndromes between 2012 and 2015 were included. The analyzed subjects comprised UBMT recipients with 8/8 matched HLA alleles (n = 1470), 7/8 matched alleles (n = 859), 6/8 matched alleles (n = 186), and recipients of PTCy-haploPBSCT (n = 133). In multivariate analyses with 8/8 matched UBMT as the reference, PTCy-haploPBSCT showed similar overall mortality, decreased risk of non-relapse mortality (NRM), increased risk of relapse, and decreased risk of grade II-IV acute graft-versus-host disease (GVHD) and chronic GVHD. Adjusted probabilities for 8/8 matched UBMT, PTCy-haploPBSCT, and 7/8 and 6/8 matched UBMT groups at 2 years post-transplant were 61%, 60%, 58%, and 52% for overall survival, 23%, 28%, 21%, and 19% for relapse, and 20%, 7%, 24%, and 33% for NRM. PTCy-haploPBSCT was associated with remarkably low NRM, contributing to survival outcomes that were comparable to 8/8 matched UBMT. The higher relapse rate in the PTCy-haploPBSCT group might be associated with the higher proportion of high-risk patients. PTCy-haploPBSCT may be a viable alternative when HLA-matched related donors are not available.
Keyphrases
- stem cell transplantation
- bone marrow
- high dose
- peripheral blood
- free survival
- mesenchymal stem cells
- newly diagnosed
- cord blood
- stem cells
- risk factors
- type diabetes
- cardiovascular events
- coronary artery disease
- cardiovascular disease
- ejection fraction
- prognostic factors
- cell proliferation
- liver failure
- signaling pathway
- patient reported outcomes
- respiratory failure
- acute respiratory distress syndrome
- big data
- weight loss
- patient reported
- pi k akt
- mechanical ventilation