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Improved Outcomes of UM171-Expanded Cord Blood Transplantation Compared with Other Graft Sources: Real-World Evidence
Cohen, S., Bambace, N., Ahmad, I., Roy, J., Tang, X., Zhang, M. J., Burns, L. J., Barabé, F., Bernard, L., Delisle, J. S., et al
Blood advances. 2023
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Abstract
Cord blood (CB) transplantation is hampered by low cell dose and high non-relapse mortality (NRM). A phase I-II trial of UM171-expanded CB transplants demonstrated safety and favourable preliminary efficacy. The aim of the current analysis was to retrospectively compare results of the phase I-II trial to those after unmanipulated CB and matched unrelated donor (MUD) transplants. Data from recipients of CB and MUD transplants were obtained from the Center for International Blood and Marrow Transplant Research (CIBMTR) database. Patients were directly matched for the number of prior allogeneic hematopoietic stem cell transplants (alloHCT), disease and refined Disease Risk Index. Patients were further matched by propensity score for age, comorbidity index and performance status. Primary endpoints included NRM, progression-free survival (PFS), overall survival (OS) and graft-versus-host disease (GVHD)-free relapse-free survival (GRFS) at 1- and 2-years post alloHCT. Overall, 137 CIBMTR (67 CB, 70 MUD) and 22 UM171-expanded CB patients were included. NRM at 1 and 2 years was lower, PFS and GRFS at 2 years and OS at 1 year were improved for UM171-expanded CBs compared to CB controls. Compared to MUD controls, UM171 patients had lower 1- and 2-year NRM, higher 2-year PFS, and higher 1- and 2-year GRFS. Furthermore, UM171-expanded CB recipients experienced less grades III-IV acute GVHD and chronic GVHD compared to MUD graft recipients. Compared to real-world evidence with CB and MUD alloHCT, this study suggests that UM171-expanded CB recipients may benefit from lower NRM and higher GRFS.
PICO Summary
Population
Adults with haematological malignancies enrolled in a clinical trial in USA and Canada, plus matched controls from CIBMTR database (n=159)
Intervention
UM171 cord blood transplant (n=22)
Comparison
Matched controls (n=137) who received cord blood (CB, n=67) or matched unrelated donor transplant (MUD, n=70)
Outcome
Non-relapse mortality (NRM) at 1 and 2 years was lower, progression free survival (PFS) and GvHD-free relapse free survival (GRFS) at 2 years and overall (OS) survival at 1 year were improved for UM171-expanded CBs compared to CB controls. Compared to MUD controls, UM171 patients had lower 1- and 2-year NRM, higher 2-year PFS, and higher 1- and 2-year GRFS. Furthermore, UM171-expanded CB recipients experienced less grades III-IV acute GVHD and chronic GVHD compared to MUD graft recipients.
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Effects of extended transport on cryopreserved allogeneic hematopoietic progenitor cell (HPC) product quality and optimal methods to assess HPC stability
Reddy, O. L., Sall, M. T., Dinh, A., Cai, Y., Ongkeko, M., Arya, N., Wilder, J., Tran, M., Jin, P., Stroncek, D. F., et al
Transfusion. 2023
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Editor's Choice
Abstract
BACKGROUND Since the beginning of the COVID-19 pandemic, cryopreservation of hematopoietic progenitor cell (HPC) products has been increasingly used to ensure allogeneic donor graft availability prior to recipient conditioning for transplantation. However, in addition to variables such as graft transport duration and storage conditions, the cryopreservation process itself may adversely affect graft quality. Furthermore, the optimal methods to assess graft quality have not yet been determined. STUDY DESIGN AND METHODS A retrospective review was performed on all cryopreserved HPCs processed and thawed at our facility from 2007 to 2020, including both those collected onsite and by the National Marrow Donor Program (NMDP). HPC viability studies were also performed on fresh products, retention vials, and corresponding final thawed products by staining for 7-AAD (flow cytometry), AO/PI (Cellometer), and trypan blue (manual microscopy). Comparisons were made using the Mann-Whitney test. RESULTS For HPC products collected by apheresis (HPC(A)), pre-cryopreservation and post-thaw viabilities, as well as total nucleated cell recoveries were lower for products collected by the NMDP compared to those collected onsite. However, there were no differences seen in CD34+ cell recoveries. Greater variation in viability testing was observed using image-based assays compared to flow-based assays, and on cryo-thawed versus fresh samples. No significant differences were observed between viability measurements obtained on retention vials versus corresponding final thawed product bags. DISCUSSION Our studies suggest extended transport may contribute to lower post-thaw viabilities, but without affecting CD34+ cell recoveries. To assess HPC viability prior to thaw, testing of retention vials offers predictive utility, particularly when automated analyzers are used.
PICO Summary
Population
Cryopreserved hematopoietic progenitor cell products (HPCs) processed and thawed at a single centre in USA from 2007 to 2020 collected on site or by the National Marrow Donor Program (n=441)
Intervention
Products collected on site (n=158)
Comparison
Products collected through the National Marrow Donor Program (NMDP) (n=283)
Outcome
For HPC products collected by apheresis (HPC(A)), pre-cryopreservation and post-thaw viabilities, as well as total nucleated cell recoveries were lower for products collected by the NMDP compared to those collected onsite. However, there were no differences seen in CD34+ cell recoveries. Greater variation in viability testing was observed using image-based assays compared to flow-based assays, and on cryo-thawed versus fresh samples. No significant differences were observed between viability measurements obtained on retention vials versus corresponding final thawed product bags.
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T-cell replete cord transplants give superior outcomes in high-risk and relapsed/refractory pediatric myeloid malignancy
Horgan, C., Mullanfiroze, K., Rauthan, A., Patrick, K., Butt, N. A., Mirci-Danicar, O., O'Connor, O., Furness, C., Deshpande, A., Lawson, S., et al
Blood advances. 2023;7(10):2155-2165
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Editor's Choice
Abstract
Stem cell transplant (SCT) outcomes in high-risk and relapsed/refractory (R/R) pediatric acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) have been historically poor. Cord blood (CB) allows T-cell replete CB transplant (TRCB), enabling enhanced graft-versus-leukemia. We consecutively collected data from 367 patients undergoing TRCB (112 patients) or other cell source (255 patients) SCT for pediatric AML/MDS in the United Kingdom and Ireland between January 2014 and December 2021. Data were collected about the patient's demographics, disease, and its treatment; including previous transplant, measurable residual disease (MRD) status at transplant, human leukocyte antigen-match, relapse, death, graft versus host disease (GvHD), and transplant-related mortality (TRM). Univariable and multivariable analyses were undertaken. There was a higher incidence of poor prognosis features in the TRCB cohort: 51.4% patients were MRD positive at transplant, 46.4% had refractory disease, and 21.4% had relapsed after a previous SCT, compared with 26.1%, 8.6%, and 5.1%, respectively, in the comparator group. Event free survival was 64.1% within the TRCB cohort, 50% in MRD-positive patients, and 79% in MRD-negative patients. To allow for the imbalance in baseline characteristics, a multivariable analysis was performed where the TRCB cohort had significantly improved event free survival, time to relapse, and reduced chronic GvHD, with some evidence of improved overall survival. The effect appeared similar regardless of the MRD status. CB transplant without serotherapy may be the optimal transplant option for children with myeloid malignancy.
PICO Summary
Population
Children with AML/MDS and receiving transplant in UK centres between 2014 and 2021 (n=367)
Intervention
T-cell replete cord blood transplant (TRCB cohort, n=112)
Comparison
Transplant from any other cell source (n=255)
Outcome
Event free survival was 64.1% within the TRCB cohort, 50% in MRD-positive patients, and 79% in MRD-negative patients. To allow for the imbalance in baseline characteristics, a multivariable analysis was performed where the TRCB cohort had significantly improved event free survival, time to relapse, and reduced chronic GvHD, with some evidence of improved overall survival. The effect appeared similar regardless of the MRD status.
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Cryopreserved versus fresh peripheral blood allogeneic stem cell transplantation outcomes in patients receiving post-transplant cyclophosphamide for graft-versus-host prophylaxis during the COVID-19 pandemic: a single center experience
Guo, M., Liu, J., Clark, P., Ahmad, S., Patel, R., Varela, J. C., Mori, S.
International journal of hematology. 2022;:1-10
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Editor's Choice
Abstract
BACKGROUND/OBJECTIVE Cryopreservation of grafts is not common practice in allogeneic hematopoietic stem cell transplant (HSCT) recipients. However, our center had to use cryopreserved cells for allogeneic HSCT during the COVID-19 pandemic to avoid delays in transplantation due to uncertainty regarding patient and donor exposures. STUDY DESIGN We retrospectively evaluated post-transplant engraftment and survival outcomes of adult patients who received cryopreserved versus fresh allografts during the COVID-19 pandemic. RESULTS Fifty-five patients with hematologic malignancies received either cryopreserved (n = 34) or fresh (n = 21) allogeneic HSCT using peripheral blood stem cells between January 2020 and December 2020. At a median follow-up time of 15 months, cryopreserved allograft recipients had significantly lower overall survival (OS) (p = 0.02). They also experienced significantly delayed neutrophil (p = 0.01) and platelet engraftments (p < 0.0001), as well as higher red blood cell transfusion-dependence after day + 60 (67.6% vs. 28.6%; p = 0.01). Significantly more cryopreserved allograft recipients received donor lymphocyte infusion than fresh allograft recipients (35.3% vs. 4.8%, p = 0.01). Neither relapse-free survival nor non-relapse mortality differed significantly between the two groups. CONCLUSION Cryopreservation of allografts in combination with post-transplant cyclophosphamide may negatively affect engraftment and OS outcomes in HSCT recipients.
PICO Summary
Population
Adults with haematologic malignancies undergoing allogeneic transplant during the COVID-19 pandemic, from a single centre in the USA (n=55)
Intervention
Cryopreserved allograft (n = 34)
Comparison
Fresh allograft (n = 21)
Outcome
At a median follow-up time of 15 months, cryopreserved allograft recipients had significantly lower overall survival (OS). They also experienced significantly delayed neutrophil and platelet engraftments, as well as higher red blood cell transfusion-dependence after day + 60 (67.6% vs. 28.6%). Significantly more cryopreserved allograft recipients received donor lymphocyte infusion than fresh allograft recipients (35.3% vs. 4.8%). Neither relapse-free survival nor non-relapse mortality differed significantly between the two groups.
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Autologous hematopoietic cell transplantation for relapsed multiple myeloma performed with cells procured after previous transplantation-study on behalf of CMWP of the EBMT
Drozd-Sokołowska, J., Gras, L., Zinger, N., Snowden, J. A., Arat, M., Basak, G., Pouli, A., Crawley, C., Wilson, K. M. O., Tilly, H., et al
Bone marrow transplantation. 2022
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Editor's Choice
Abstract
Autologous hematopoietic cell transplantation (auto-HCT) may be performed in multiple myeloma (MM) patients relapsing after a previous auto-HCT. For those without an adequate dose of stored stem cells, remobilization is necessary. This retrospective study included patients who, following disease relapse after the first auto-HCT(s), underwent stem cell remobilization and auto-HCT performed using these cells. There were 305 patients, 68% male, median age at salvage auto-HCT was 59 years. The median time to relapse after the first-line penultimate auto-HCT(s) was 30.6 months, the median follow-up after salvage auto-HCT 31 months. The 2- and 4-year non-relapse mortality (NRM) after the salvage auto-HCT was 5 and 9%, the relapse incidence 56 and 76%, respectively. Overall survival (OS) after 2 and 4 years was 76 and 52%, progression-free survival (PFS) 39 and 15%. In multivariable analysis an increasing interval between the penultimate auto-HCT and relapse was associated with better OS and PFS, later calendar year of salvage auto-HCT with better OS. In conclusion, salvage auto-HCT performed with cells remobilized after a previous auto-HCT was associated with acceptable NRM. The leading cause of failure was disease progression of MM, which correlated with a shorter interval from the penultimate auto-HCT to the first relapse.
PICO Summary
Population
Patients with multiple myeloma who relapsed after first autologous stem cell transplant (n=305)
Intervention
Stem cell remobilisation and autologous stem cell transplant (auto-HCT)
Comparison
None
Outcome
The median time to relapse after the first-line penultimate auto-HCT(s) was 30.6 months, the median follow-up after salvage auto-HCT 31 months. The 2- and 4-year non-relapse mortality (NRM) after the salvage auto-HCT was 5 and 9%, the relapse incidence 56 and 76%, respectively. Overall survival (OS) after 2 and 4 years was 76 and 52%, progression-free survival (PFS) 39 and 15%. In multivariable analysis an increasing interval between the penultimate auto-HCT and relapse was associated with better OS and PFS, later calendar year of salvage auto-HCT with better OS.
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Neither COVID-19, nor cryopreservation, prevented allogeneic product infusion: A report from the National Marrow Donor Program
Farhadfar, N., Newman, J., Novakovich, J., Barten, J., Ndifon, E. T., Oakes, J., Cody, M., Pham, H. P., Auletta, J. J., Miller, J. P., et al
Frontiers in immunology. 2022;13:937900
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Editor's Choice
Abstract
BACKGROUND The Coronavirus Disease 2019 (COVID-19) pandemic in early 2020 has resulted in an unprecedented level of uncertainty and challenge for the stem cell donor registries. To address these challenges, rapid strategies were implemented by the National Marrow Donor Registry (NMDP) and its network partners. Herein, we aim to report the impact of the COVID-19 pandemic on the collection, utilization of grafts, and short-term outcomes of patients who received stem cell products from COVID-19-positive donors. METHODS NMDP data during the early phase (1 March 2020 through 1 May 2020) of the pandemic were compared to the later phase (1 March 2021 through 1 May 2021). Odds ratios were calculated to determine the impact of the pandemic on graft sources requested by transplant centers (TCs). The Kruskal-Wallis test was used to test the effect of the pandemic on the disease indication, volume of searches, and number of products not infused. RESULTS Although there was an initial decline in overall donor searches during the early phase of the pandemic, these numbers increased reaching pre-pandemic levels during the later phase. Urgent malignant diseases remained the most common indication for transplant in 2021. The pandemic necessitated cryopreservation of stem cell products due to transportation restrictions as well as clinical uncertainties in managing the virus. Cryopreserved grafts remained the most common requested grafts throughout the pandemic. In the later phase of the pandemic, the total numbers of requests for fresh grafts increased, mostly due to the increase in requests for fresh bone marrow (BM) grafts. As the pandemic continued, TCs became more accepting of cryopreservation, resulting in a reduction in the number of products not infused. Lastly, no short-term deleterious outcomes were noted among the patients who had stem cell products infused from a SARS-CoV-2-positive donor. CONCLUSION Throughout the pandemic, the NMDP and TCs worked tirelessly to ensure that patients would receive lifesaving grafts when needed. The data reported here, although limited by small numbers, illustrate that transplantation from donors with COVID-19 is feasible and safe.
PICO Summary
Population
Data on allogeneic transplants reported to the CIBMTR registry
Intervention
Donor collection and infusion dates for the period March 2020 – July 2020
Comparison
Donor collection and infusion dates for the period March 2021 – July 2021
Outcome
Although there was an initial decline in overall donor searches during the early phase of the pandemic, these numbers increased reaching pre-pandemic levels during the later phase. Urgent malignant diseases remained the most common indication for transplant in 2021. The pandemic necessitated cryopreservation of stem cell products due to transportation restrictions as well as clinical uncertainties in managing the virus. Cryopreserved grafts remained the most common requested grafts throughout the pandemic. In the later phase of the pandemic, the total numbers of requests for fresh grafts increased, mostly due to the increase in requests for fresh bone marrow grafts. As the pandemic continued, transplant centres became more accepting of cryopreservation, resulting in a reduction in the number of products not infused. Lastly, no short-term deleterious outcomes were noted among the patients who had stem cell products infused from a SARS-CoV-2-positive donor.
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Impact of in vivo T-cell depletion in patients with myelodysplastic syndromes undergoing allogeneic hematopoietic stem cell transplant: a registry study from the Chronic Malignancies Working Party of the EBMT
Forcade, E., Chevret, S., Finke, J., Ehninger, G., Ayuk, F., Beelen, D., Koster, L., Ganser, A., Volin, L., Sengeloev, H., et al
Bone marrow transplantation. 2022
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Editor's Choice
Abstract
While in vivo T-cell depletion (TCD) is widely used, its benefit in patients with MDS still remains a matter of debate. This study evaluates the impact of TCD on outcomes, and compares ATG and alemtuzumab, in patients with MDS. 1284 patients from the EBMT registry were included in this study with 470 patients in the no-TCD group and 814 in the TCD group (alemtuzumab N = 168; ATG N = 646). At 6 months, aGVHD III-IV cumulative incidences (CI) for no-TCD, ATG or alemtuzumab groups were 13% vs 14% vs 11% (ns), respectively. At 5 years, CI of chronic GVHD were 64% vs 52% vs 51% (p < 0.00017); and CI of relapse was 23% vs 25% vs 39% (p < 0.0001) for no TCD, ATG and alemtuzumab respectively; OS was 47% vs 46% vs 34% (p = 0.009) respectively; and GRFS was 21% vs 28% and 20% (p = 0.045) respectively. In multivariable analysis, ATG improved GRFS, and alemtuzumab decreased OS. Both ATG and alemtuzumab decreased risk of chronic GVHD, but the increased risk of relapse with alemtuzumab is associated with a poor GRFS and suggest to not use alemtuzumab in the setting of allo-SCT for high risk disease.
PICO Summary
Population
Patients with myelodysplastic syndromes undergoing allogeneic transplant and reported to the EBMT registry (n=1284)
Intervention
In vivo T-cell depletion (TCD, n=814: receiving alemtuzumab n=168 or ATG n=646)
Comparison
No in vivo T-cell depletion (No-TCD, n=470).
Outcome
At 6 months, aGVHD III-IV cumulative incidences (CI) for no-TCD, ATG or alemtuzumab groups were 13% vs 14% vs 11% (ns), respectively. At 5 years, CI of chronic GVHD were 64% vs 52% vs 51%; and CI of relapse was 23% vs 25% vs 39% for no TCD, ATG and alemtuzumab respectively; OS was 47% vs 46% vs 34% respectively; and GRFS was 21% vs 28% and 20% respectively. In multivariable analysis, ATG improved GRFS, and alemtuzumab decreased OS. Both ATG and alemtuzumab decreased risk of chronic GVHD, but the increased risk of relapse with alemtuzumab is associated with a poor GRFS
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8.
ATG and Post-transplant Cyclophosphamide predisposes to inferior outcome when using cryopreserved stem cell grafts
Novitzky-Basso, I., Remberger, M., Chen, C., Pasic, I., Lam, W., Law, A., Gerbitz, A., Viswabandya, A., Lipton, J. H., Kim, D. D., et al
European journal of haematology. 2021
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Editor's Choice
Abstract
During 2020, the concurrent novel COVID-19 pandemic lead to widespread cryopreservation of allogeneic HCT grafts based on NMDP and EBMT recommendations, in order to secure grafts before the start of conditioning chemotherapy. We sought to examine the impact of this change in practice on patient outcomes. We analyzed the outcomes of 483 patients who received HSCT between August 2017 and August 2020, at Princess Margaret Cancer Centre, Canada, in the retrospective study, comparing the outcomes between those who received cryopreserved or fresh peripheral blood stem cell grafts. Overall compared to those who received fresh grafts (n=348), patients who received cryopreserved grafts (n=135) had reduced survival and GRFS, reduced incidence of chronic GvHD, delay in neutrophil engraftment and higher graft failure, with no significant difference in relapse incidence or acute GvHD. However, recipients of cryopreserved matched related donor HSCT showed significantly worse OS, NRM, GRFS compared to fresh grafts. Multivariable analysis of the entire cohort showed significant impact of cryopreservation on OS, relapse, cGvHD, graft failure and GRFS. We conclude that cryopreservation was associated with inferior outcomes post-HSCT, possibly due to the combination of ATG and post-transplant cyclophosphamide impacting differential tolerance to cryopreservation on components of the stem cell graft; further studies are warranted to elucidate mechanisms for this observation.
PICO Summary
Population
Patients who received HSCT during a three year period, at a single centre in Canada (n=483)
Intervention
Cryopreserved grafts (n=135)
Comparison
Fresh grafts (n=348)
Outcome
Overall compared to those who received fresh grafts, patients who received cryopreserved grafts had reduced survival and GRFS, reduced incidence of chronic GvHD, delay in neutrophil engraftment and higher graft failure, with no significant difference in relapse incidence or acute GvHD. However, recipients of cryopreserved matched related donor HSCT showed significantly worse OS, NRM, GRFS compared to fresh grafts. Multivariable analysis of the entire cohort showed significant impact of cryopreservation on OS, relapse, cGvHD, graft failure and GRFS.
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9.
Hematopoietic Cell Transplantation with Cryopreserved Grafts for Severe Aplastic Anemia
Eapen, M., Zhang, M. J., Tang, X. Y., Lee, S. J., Fei, M. W., Wang, H. L., Hebert, K. M., Arora, M., Chhabra, S., Devine, S. M., et al
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 2020
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Editor's Choice
Abstract
With the COVID-19 pandemic and the ensuing barriers to the collection and transport of donor cells, it is often necessary to collect and cryopreserve grafts before initiation of transplantation conditioning. The effect on transplantation outcomes in nonmalignant disease is unknown. This analysis examined the effect of cryopreservation of related and unrelated donor grafts for transplantation for severe aplastic anemia in the United States during 2013 to 2019. Included are 52 recipients of cryopreserved grafts who were matched for age, donor type, and graft type to 194 recipients who received noncryopreserved grafts. Marginal Cox regression models were built to study the effect of cryopreservation and other risk factors associated with outcomes. We recorded higher 1-year rates of graft failure (hazard ratio [HR], 2.26; 95% confidence interval, 1.17 to 4.35; P=.01) and of 1-year overall mortality (HR, 3.13; 95% CI, 1.60 to 6.11; P=.0008) after transplantation of cryopreserved compared with noncryopreserved grafts, with adjustment for sex, performance score, comorbidity, cytomegalovirus serostatus, and ABO blood group match. The incidence of acute and chronic graft-versus-host disease did not differ between the 2 groups. Adjusted probabilities of 1-year survival were 73% (95% CI, 60% to 84%) in the cryopreserved graft group and 91% (95% CI, 86% to 94%) in the noncryopreserved graft group. These data support the use of noncryopreserved grafts whenever possible in patients with severe aplastic anemia.
PICO Summary
Population
Patients with severe aplastic anaemia, who underwent HSCT and were reported to CIBMTR registry
Intervention
Cryopreseverved graft (n=52)
Comparison
Matched controls who received non-cryopreserved grafts (n=194)
Outcome
. We recorded higher 1-year rates of graft failure and of 1-year overall after transplantation of cryopreserved compared with noncryopreserved grafts, with adjustment for sex, performance score, comorbidity, cytomegalovirus serostatus, and ABO blood group match. The incidence of acute and chronic graft-versus-host disease did not differ between the 2 groups. Adjusted probabilities of 1-year survival were 73% in the cryopreserved graft group and 91% in the noncryopreserved graft group.
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10.
Fresh versus Frozen Allogeneic Peripheral Blood Stem Cell Grafts: a Successful Timely Option
Alotaibi, A. S., Prem, S., Chen, S., Lipton, J. H., Kim, D. D., Viswabandya, A., Kumar, R., Lam, W., Law, A. D., Mattsson, J., et al
American journal of hematology. 2020
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Editor's Choice
Abstract
Cryopreservation of grafts has been established in autologous and cord blood transplantation, yet there is little experience regarding the effect of cryopreservation with sibling and unrelated grafts. We evaluated the effect of cryopreservation of grafts on allogeneic transplant outcomes using related, unrelated and haploidentical donors, including 958 patients, age 18-74 years (median 55) and using PBSC for various hematologic malignancies. Fresh grafts were received by 648 (68%) patients, 310 (32%) received cryopreserved. There was no difference between fresh versus cryopreserved grafts for neutrophil engraftment (p=0.09), platelet engraftment (p=0.11), graft failure (5.6% versus 6.8%, p=0.46) and grade II-IV acute GVHD (p=0.71), moderate/severe chronic GVHD was observed in 176 (27%) versus 123 (40%) patients, respectively (p<0.001). Multivariable analysis demonstrated no difference between fresh versus cryopreserved for OS (p=0.39) and CIR (p=0.08) while fresh grafts demonstrated borderline increased NRM (HR 1.27, 95%CI 1.02-1.59, p=0.04). Of note, for patients with no or mild chronic GVHD, CIR was less for fresh compared to cryopreserved (HR=0.67 for fresh, 95% CI 0.48-0.92, p=0.01). We conclude there were no differences in engraftment and survival between fresh and cryopreserved grafts for allogeneic HCT, thus establishing cryopreservation to be a safe option for allogeneic HCT. This article is protected by copyright. All rights reserved.
PICO Summary
Population
Adult patients with various haematologic malignancies requiring allogeneic transplant (n=953)
Intervention
Cryopreserved grafts (n=310)
Comparison
Fresh grafts (n=648)
Outcome
There was no difference between fresh versus cryopreserved grafts for neutrophil engraftment, platelet engraftment, graft failure (5.6% versus 6.8%) and grade II-IV acute GVHD. Moderate/severe chronic GVHD was observed in 176 (27%) versus 123 (40%) patients, respectively. Multivariable analysis demonstrated no difference between fresh versus cryopreserved for OS and CIR while fresh grafts demonstrated borderline increased NRM (HR 1.27). Of note, for patients with no or mild chronic GVHD, CIR was less for fresh compared to cryopreserved (HR=0.67 for fresh, 95%).