1. Donor Type Does Not Impact Late Graft Failure Following Reduced-Intensity Allogeneic Hematopoietic Cell Transplantation with Post-Transplant Cyclophosphamide-Based Graft-Versus-Host Disease Prophylaxis.
- Author
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Hickey CL, Zhang MJ, Allbee-Johnson M, Romee R, Majhail NS, Malki MMA, Antin JH, Benjamin CL, Bredeson C, Chhabra S, Grunwald MR, Inamoto Y, Kanakry CG, Milano F, Soiffer RJ, Solomon SR, Spellman SR, Brunstein CG, and Cutler C
- Subjects
- Humans, Middle Aged, Male, Female, Adult, Retrospective Studies, Aged, Transplantation, Homologous, Graft Rejection prevention & control, Tissue Donors statistics & numerical data, Leukemia, Myeloid, Acute therapy, Cyclophosphamide therapeutic use, Hematopoietic Stem Cell Transplantation adverse effects, Hematopoietic Stem Cell Transplantation methods, Graft vs Host Disease prevention & control, Graft vs Host Disease epidemiology, Transplantation Conditioning methods
- Abstract
Background: Post-transplant cyclophosphamide (PTCy) is a commonly used graft-vs-host disease (GVHD) prophylaxis, particularly in the setting of haploidentical (haplo) hematopoietic cell transplantation (HCT). The rate of graft failure has been reported to be as high as 12% to 20% in haplo-HCT recipients using PTCy. The objective of this study was to determine whether donor type influenced the risk of late graft failure following reduced-intensity conditioning (RIC) HCT using PTCy-based GVHD prophylaxis., Study Design: A retrospective cohort analysis using the Center for International Blood and Marrow Transplant Research (CIBMTR) database among adult patients who underwent first RIC haplo or 8/8 matched unrelated donor (MUD) HCT between 2011 and 2018 for acute myeloblastic leukemia (AML), acute lymphoblastic leukemia (ALL) or myelodysplastic syndrome (MDS) with PTCy GVHD prophylaxis. The primary outcome was incidence of late graft failure, defined as secondary graft loss in the absence of relapse or poor graft function requiring a cellular therapy intervention., Results: A total of 1336 patients met the eligibility criteria (1151 haplo, 185 MUD). Patients in the MUD group were older (65 vs. 61 years), less ethnically diverse (95% vs. 72% White), received fewer bone marrow grafts (45% vs. 16%), and had younger donors (median age, 28 vs. 37 years old). Conditioning regimens were predominately fludarabine, cyclophosphamide, and total body irradiation (TBI; 87% haplo and 38% MUD). At 2 years, the adjusted probabilities of late graft failure for the haplo group was 6.5% (95% confidence interval [CI], 5.2-8.0) versus 5.9% (95% CI, 2.7%-10.9%) for the MUD group (P = .79). Multivariate analysis for risk factors associated with late graft failure found associations with a diagnosis of MDS (HR, 1.98; 95% CI, 1.22-3.20; P = .005), and earlier year of HCT (2015-2018 vs. 2011-2014; HR, 0.39; 95% CI, 0.24-0.64; P = .0002). A post-hoc sensitivity analysis was performed to evaluate the effect of donor age and use of peripheral blood stem cell (PBSC) grafts. Graft failure did not differ between haplo and MUD HCT (HR, 1.19; P = .67) when adjusted for donor age nor when restricted to PBSC grafts only (HR, 0.85; P = .70)., Conclusion: In this registry-based analysis of patients undergoing RIC HCT for AML, ALL, or MDS using GVHD prophylaxis with PTCy, there was no significant difference in late graft failure rates between haplo and MUD donors. Overall rates of late graft failure were high., Competing Interests: Declaration of competing interest Dr. Grunwald reports consulting fees from Amgen, Aptitude Health, Astellas Pharma, Blueprint Medicines, Bristol Myers Squibb, Cardinal Health, Daiichi Sankyo, Genentech, GSK, Incyte Corporation, Jazz Pharmaceuticals, OncLive, Pfizer, Premier, Sanofi, Servier, and Sobi; research funding from Ajax Pharmaceuticals, Incyte Corporation, Janssen, and Merck; and equity/stockholder from Medtronic. Dr. Cutler reports consulting fees/honoraria from Sanofi, CSL Behring, Incyte, CareDx, and Syndax; and consulting fees/equity from Cimeio, Oxford Immune Algorithmics, and OrcaBio. Dr. Soiffer reports consulting fees from Astellas, Amgen, Vor Biopharma, Smart Immune, Neovii, Bluesphere Bio, and Jasper; and is on the Data Safety Monitoring Board for BMS and Board of Directors for NMDP., (Copyright © 2025 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.)
- Published
- 2025
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