1.
Impact of donor types on reduced-intensity conditioning allogeneic stem cell transplant for mature lymphoid malignancies
Imahashi, N., Terakura, S., Kondo, E., Kato, K., Kim, S. W., Shinohara, A., Watanabe, M., Fukuda, T., Uchida, N., Kobayashi, H., et al
Bone marrow transplantation. 2021
Abstract
We retrospectively compared the outcomes of reduced-intensity conditioning (RIC) transplantation from matched related donors (MRD; n?=?266), matched unrelated donors (MUD; n?=?277), and umbilical cord blood (UCB; n?=?513) for mature lymphoid malignancies. The 3-year overall survival rates for the MRD, MUD, and UCB groups were 54%, 59%, and 40%, respectively (P?0.001). Multivariate analysis showed no differences in survival between the MRD group and the MUD or UCB group. However, survival was significantly affected by the conditioning regimen and graft-versus-host disease (GVHD) prophylaxis in the UCB group, but not in the MRD and MUD groups. Notably, multivariate analysis showed that the risk of overall mortality in the UCB recipients who received the optimal conditioning regimen and GVHD prophylaxis (n?=?116) was lower than that in the MRD group (relative risk [RR], 0.69; P?=?0.03) and tended to be lower than that in the MUD group (RR, 0.75; P?=?0.09). Our results suggest that UCB transplantation performed with the optimal conditioning regimen and GVHD prophylaxis is highly effective. Moreover, UCB is readily available. Thus, UCB transplantation with the optimal conditioning regimen and GVHD prophylaxis is preferable to MUD transplantation when MRD are not available in the setting of RIC transplantation for mature lymphoid malignancies.
2.
Influence of donor type (sibling vs matched-unrelated donor vs haplo-identical donor) on outcomes after clofarabine-based reduced-intensity conditioning allograft for myeloid malignancies
Bouard, L., Guillaume, T., Peterlin, P., Garnier, A., Le Bourgeois, A., Duquenne, A., Mahe, B., Dubruille, V., Blin, N., Touzeau, C., et al
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 2019
Abstract
Clofarabine-based reduced-intensity conditioning (RIC) regimens are well-established schedules for allograft in patients with myeloid malignancies. A retrospective study was conducted including all adults allografted in our department with such a regimen and disease with the aim to assess whether or not the donor type (matched sibling (MSD), unrelated (MUD), or haploidentical (haplo)) impacted outcomes. Between October 2009 and February 2018, 118 patients met the inclusion criteria. Thirty-six, 55 and 27 patients respectively received a graft from a MSD, MUD or haplo donor. Peripheral blood stem cells (PBSC) were the source of graft for all patients. The median age of the whole cohort was 62 years old (range: 20-73) and the median follow-up was 31 months (range: 4.5-106). All patients engrafted except 1 haplo recipient. Neutrophils (>0.5 10(9)/L) and platelets (50 10(9)/L) recoveries were significantly delayed in the haplo-group (p=0.0003; and p<0.0001) compared to MSD and MUD. Acute grade 2-4 or 3-4 graft versus host disease (GVHD) incidences were similar between the three groups as well as the incidence of moderate or severe chronic GVHD. Also, similar 2-year overall survival (OS, 64.7% vs 73.9% vs 60.2%, p=0.39), disease-free survival (DFS, 57.7% vs 70.9% vs and 53.6%, p=0.1) and GVHD-relapse free survival (37.9% vs 54.3% vs 38.9%, p=0.23) were observed between MSD vs MUD vs haplo groups. The same was true when considering only acute myeloid leukemia (AML) cases. In multivariate analysis, the type of donor remained independent of outcomes in this series while myelodysplastic syndrome (vs AML), high disease-risk index and older donor (>=50 years) were associated with lower OS and DFS. These data suggest that haplo-identical donors are an acceptable alternative for patients receiving a clofarabine-based RIC PBSC allograft for myeloid malignancies who lack a MSD or a MUD.
4.
Unrelated donors are associated with improved relapse-free survival compared to related donors in patients with myelodysplastic syndrome undergoing reduced intensity allogeneic stem cell transplantation
Yam, C., Crisalli, L., Luger, S. M., Loren, A. W., Hexner, E. O., Frey, N. V., Mangan, J. K., Gao, A., Stadtmauer, E. A., Porter, D. L., et al
American Journal of Hematology. 2016;91(9):883-7
Abstract
Reduced intensity allogeneic stem cell transplantation (RI alloSCT) is a potentially curative treatment approach for patients with myelodysplastic syndrome (MDS). It is currently unclear if older related donors are better than younger unrelated donors for patients with MDS undergoing RI alloSCT. We retrospectively studied 53 consecutive MDS patients who underwent RI alloSCT between April 2007 and June 2014 and evaluated associations between donor type and outcomes with adjustment for significant covariates. 34 patients (median age: 64 years) and 19 patients (median age: 60 years) received allografts from unrelated and related donors, respectively. Unrelated donors were younger than related donors (median age: 32 vs. 60 years, P<0.0001). There were no significant differences in baseline disease characteristics of patients receiving allografts from related or unrelated donors. Patients who received allografts from unrelated donors had a lower relapse risk (adjusted hazard ratio [aHR]=0.35, P=0.012) and improved relapse-free survival (aHR=0.47, P=0.018). HLA mismatched unrelated donors were associated with a higher risk of grade 2-4 acute graft versus host disease (GVHD) (HR=4.64, P=0.002) without an accompanying increase in the risk of non-relapse mortality (P=0.56). Unrelated donors provided a higher mean CD8 cell dose (P=0.014) and were associated with higher median donor T cell chimerism at day 60 (P=0.003) and day 100 (P=0.03). In conclusion, patients with MDS who received allografts from unrelated donors had a lower risk of relapse and improved relapse-free survival when compared to patients who received allografts from related donors. These findings should be confirmed in a prospective study. Am. J. Hematol. 91:883-887, 2016. © 2016 Wiley Periodicals, Inc.