TY - JOUR
T1 - Composite GRFS and CRFS Outcomes after Adult Alternative Donor HCT
AU - Mehta, Rohtesh S.
AU - Holtan, Shernan G.
AU - Wang, Tao
AU - Hemmer, Michael T.
AU - Spellman, Stephen R.
AU - Arora, Mukta
AU - Couriel, Daniel R.
AU - Alousi, Amin M.
AU - Pidala, Joseph
AU - Abdel Azim, Hisham
AU - Agrawal, Vaibhav
AU - Ahmed, Ibrahim
AU - Al-Homsi, A. Samer
AU - Aljurf, Mahmoud
AU - Antin, Joseph H.
AU - Askar, Medhat
AU - Auletta, Jeffery J.
AU - Bhatt, Vijaya Raj
AU - Chee, Lynette
AU - Chhabra, Saurabh
AU - Daly, Andrew
AU - DeFilipp, Zachariah
AU - Gajewski, James
AU - Gale, Robert Peter
AU - Gergis, Usama
AU - Hematti, Peiman
AU - Hildebrandt, Gerhard C.
AU - Hogan, William J.
AU - Inamoto, Yoshihiro
AU - Martino, Rodrigo
AU - Majhail, Navneet S.
AU - Marks, David I.
AU - Nishihori, Taiga
AU - Olsson, Richard F.
AU - Pawarode, Attaphol
AU - Diaz, Miguel Angel
AU - Prestidge, Tim
AU - Rangarajan, Hemalatha G.
AU - Ringden, Olle
AU - Saad, Ayman
AU - Savani, Bipin N.
AU - Schoemans, Hélène
AU - Seo, Sachiko
AU - Schultz, Kirk R.
AU - Solh, Melhem
AU - Spitzer, Thomas
AU - Storek, Jan
AU - Teshima, Takanori
AU - Verdonck, Leo F.
AU - Wirk, Baldeep
AU - Yared, Jean A.
AU - Cahn, Jean Yves
AU - Weisdorf, Daniel J.
N1 - Publisher Copyright:
© 2020 by American Society of Clinical Oncology.
PY - 2020/5/4
Y1 - 2020/5/4
N2 - PURPOSE There is no consensus on the best choice of an alternative donor (umbilical cord blood [UCB], haploidentical, one-antigen mismatched [7/8]–bone marrow [BM], or 7/8-peripheral blood [PB]) for hematopoietic cell transplantation (HCT) for patients lacking an HLA-matched related or unrelated donor. METHODS We report composite end points of graft-versus-host disease (GVHD)–free relapse-free survival (GRFS) and chronic GVHD (cGVHD)–free relapse-free survival (CRFS) in 2,198 patients who underwent UCB (n 5 838), haploidentical (n 5 159), 7/8-BM (n 5 241), or 7/8-PB (n 5 960) HCT. All groups were divided by myeloablative conditioning (MAC) intensity or reduced intensity conditioning (RIC), except haploidentical group in which most received RIC. To account for multiple testing, P, .0071 in multivariable analysis and P, .00025 in direct pairwise comparisons were considered statistically significant. RESULTS In multivariable analysis, haploidentical group had the best GRFS, CRFS, and overall survival (OS). In the direct pairwise comparison of other groups, among those who received MAC, there was no difference in GRFS or CRFS among UCB, 7/8-BM, and 7/8-PB with serotherapy (alemtuzumab or antithymocyte globulin) groups. In contrast, the 7/8-PB without serotherapy group had significantly inferior GRFS, higher cGVHD, and a trend toward worse CRFS (hazard ratio [HR], 1.38; 95% CI, 1.13 to 1.69; P 5 .002) than the 7/8-BM group and higher cGVHD and trend toward inferior CRFS (HR, 1.36; 95% CI, 1.14 to 1.63; P 5 .0006) than the UCB group. Among patients with RIC, all groups had significantly inferior GRFS and CRFS compared with the haploidentical group. CONCLUSION Recognizing the limitations of a registry retrospective analysis and the possibility of center selection bias in choosing donors, our data support the use of UCB, 7/8-BM, or 7/8-PB (with serotherapy) grafts for patients undergoing MAC HCT and haploidentical grafts for patients undergoing RIC HCT. The haploidentical group had the best GRFS, CRFS, and OS of all groups.
AB - PURPOSE There is no consensus on the best choice of an alternative donor (umbilical cord blood [UCB], haploidentical, one-antigen mismatched [7/8]–bone marrow [BM], or 7/8-peripheral blood [PB]) for hematopoietic cell transplantation (HCT) for patients lacking an HLA-matched related or unrelated donor. METHODS We report composite end points of graft-versus-host disease (GVHD)–free relapse-free survival (GRFS) and chronic GVHD (cGVHD)–free relapse-free survival (CRFS) in 2,198 patients who underwent UCB (n 5 838), haploidentical (n 5 159), 7/8-BM (n 5 241), or 7/8-PB (n 5 960) HCT. All groups were divided by myeloablative conditioning (MAC) intensity or reduced intensity conditioning (RIC), except haploidentical group in which most received RIC. To account for multiple testing, P, .0071 in multivariable analysis and P, .00025 in direct pairwise comparisons were considered statistically significant. RESULTS In multivariable analysis, haploidentical group had the best GRFS, CRFS, and overall survival (OS). In the direct pairwise comparison of other groups, among those who received MAC, there was no difference in GRFS or CRFS among UCB, 7/8-BM, and 7/8-PB with serotherapy (alemtuzumab or antithymocyte globulin) groups. In contrast, the 7/8-PB without serotherapy group had significantly inferior GRFS, higher cGVHD, and a trend toward worse CRFS (hazard ratio [HR], 1.38; 95% CI, 1.13 to 1.69; P 5 .002) than the 7/8-BM group and higher cGVHD and trend toward inferior CRFS (HR, 1.36; 95% CI, 1.14 to 1.63; P 5 .0006) than the UCB group. Among patients with RIC, all groups had significantly inferior GRFS and CRFS compared with the haploidentical group. CONCLUSION Recognizing the limitations of a registry retrospective analysis and the possibility of center selection bias in choosing donors, our data support the use of UCB, 7/8-BM, or 7/8-PB (with serotherapy) grafts for patients undergoing MAC HCT and haploidentical grafts for patients undergoing RIC HCT. The haploidentical group had the best GRFS, CRFS, and OS of all groups.
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U2 - 10.1200/JCO.19.00396
DO - 10.1200/JCO.19.00396
M3 - Article
C2 - 32364845
AN - SCOPUS:85086748427
SN - 0732-183X
VL - 38
SP - 2062
EP - 2076
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 18
ER -
