1.
Outcomes of Salvage Haploidentical Transplant with Post-transplant Cyclophosphamide for Rescuing Graft Failure Patients: a Report on behalf of the Francophone Society of Bone Marrow Transplantation and Cellular Therapy
Prata, P. H., Resche-Rigon, M., Blaise, D., Socie, G., Rohrlich, P. S., Milpied, N., Turlure, P., Nguyen, S., Sirvent, A., Bulabois, C. E., et al
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 2019
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Editor's Choice
Abstract
Prognosis of patients with graft failure is dismal, and re-transplantation is the sole option for long-term survival. To address the interest of haploidentical transplantation as a salvage option in this context, we analyzed data from 24 patients with graft failure or loss re-transplanted with a haploidentical donor who received post-transplant cyclophosphamide (PT-Cy) as graft-versus-host disease prophylaxis (GvHD). Fludarabine-based reduced intensity conditioning was used in 23 patients, and 14 patients received the Baltimore regimen. The median delay between previous and salvage transplantation for graft failure was 63 (39-98) days. Besides PT-Cy, all patients received cyclosporine, and 22 patients also received MMF for GvHD prophylaxis. With a median follow up of 353 (16-2010) days, 1-year OS was 56% (95% CI: 38 - 81). Transplant complications accounted for 80% of deaths. The cumulative incidence of neutrophil engraftment was +30 was 79%. Cumulative incidence of grade II-IV acute GvHD at day-100 was 14%, and 1-year CI of chronic GvHD was 31%. One-year CI of relapse was 13%. Stem cell source did not impact on engraftment, GvHD, relapse nor overall survival. Salvage haploidentical transplant with PT-Cy for rescuing graft failure patients leads to an acceptable 1-year OS and might be a valid option in this poor situation.
PICO Summary
Population
Patients with graft failure or loss (n=24)
Intervention
Re-transplantation with a haploidentical donor who received post-transplant cyclophosphamide (PT-Cy) as graft-versus-host disease prophylaxis.
Comparison
None
Outcome
With a median follow up of 353 days, 1-year OS was 56%. Transplant complications accounted for 80% of deaths. The cumulative incidence of neutrophil engraftment was +30 was 79%. Cumulative incidence of grade II-IV acute GvHD at day-100 was 14%, and 1-year CI of chronic GvHD was 31%. One-year CI of relapse was 13%. Stem cell source did not impact on engraftment, GvHD, relapse nor overall survival.
2.
The European Society for Blood and Marrow Transplantation (EBMT) Consensus Guidelines for the Detection and Treatment of Donor-specific Anti-HLA Antibodies (DSA) in Haploidentical Hematopoietic Cell Transplantation
Ciurea, S. O., Cao, K., Fernandez-Vina, M., Kongtim, P., Malki, M. A., Fuchs, E., Luznik, L., Huang, X. J., Ciceri, F., Locatelli, F., et al
Bone Marrow Transplantation. 2018;53(5):521-534
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Abstract
Haploidentical donors are now increasingly considered for transplantation in the absence of HLA-matched donors or when an urgent transplant is needed. Donor-specific anti-HLA antibodies (DSA) have been recently recognized as an important barrier against successful engraftment of donor cells, which can affect transplant survival. DSA appear more prevalent in this type of transplant due to higher likelihood of alloimmunization of multiparous females against offspring's HLA antigens, and the degree of mismatch. Here we summarize the evidence for the role of DSA in the development of primary graft failure in haploidentical transplantation and provide consensus recommendations from the European Society for Blood and Marrow Transplant Group on testing, monitoring, and treatment of patients with DSA receiving haploidentical hematopoietic progenitor cell transplantation.
Clinical Commentary
What is known?
NIHMS1586888
What did this paper set out to examine?
What did they show?
What are the implications for practice and for future work?