Asad Bashey, Blood and Marrow Transplant Program at Northside Hospital, 5670 Peachtree Dunwoody Rd NE, Suite 1030, Atlanta, GA
Mei-Jie Zhang, Medical College of Wisconsin, Milwaukee, WI
Shannon R McCurdy, Johns Hopkins Hospital, Baltimore, MD
Andrew St Martin, Medical College of Wisconsin, Milwaukee, WI
Trevor Argall, Medical College of Wisconsin, Milwaukee, WI
Claudio Anasetti, H. Lee Moffitt Cancer Center, Research Institute, Tampa, FL
Stefan O Ciurea, MD Anderson Cancer Center, Houston, TX
Omotayo Fasan, Center for Bone Marrow Transplantation at Geisinger Medical Center, Danville
Sameh Gaballa, MD, Thomas Jefferson University Hospital, Philadelphia, PAFollow
Mehdi Hamadani, Medical College of Wisconsin, Milwaukee, WI
Pashna Munshi, MedStar Georgetown University Hospital, Washington, DC
Monzr M Al Malki, City of Hope National Medical Center, Duarte, CA
Ryotaro Nakamura, City of Hope National Medical Center, Duarte, CA
Paul V O'Donnell, Massachusetts General Hospital, Boston, MA
Miguel-Angel Perales, Memorial Sloan Kettering Cancer Center, New York, NY
Kavita Raj, King’s College Hospital, London, United Kingdom
Rizwan Romee, Barnes Jewish Hospital, St Louis, MO
Scott Rowley, MedStar Georgetown University Hospital, Washington, DC; Hackensack University Medical Center, Hackensack, NJ
Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom
Rachel B Salit, Fred Hutchinson Cancer Research Center, Seattle, WA
Melhem Solh, Blood and Marrow Transplant Program at Northside Hospital, 5670 Peachtree Dunwoody Rd NE, Suite 1030, Atlanta, GAFollow
Robert J Soiffer, Dana-Farber Cancer Institut
Ephraim Joseph Fuchs, Johns Hopkins Hospital, Baltimore, MD
Mary Eapen, Medical College of Wisconsin, Milwaukee, WI

Document Type

Article

Publication Date

9-10-2017

Comments

This article has been peer reviewed. It was published in: Journal of Clinical Oncology.

Volume 35, Issue 26, 10 September 2017, Pages 3002-3009.

The published version is available at DOI: 10.1200/JCO.2017.72.8428

Copyright © 2017 by American Society of Clinical Oncology

Abstract

Purpose T-cell-replete HLA-haploidentical donor hematopoietic transplantation using post-transplant cyclophosphamide was originally described using bone marrow (BM). With increasing use of mobilized peripheral blood (PB), we compared transplant outcomes after PB and BM transplants. Patients and Methods A total of 681 patients with hematologic malignancy who underwent transplantation in the United States between 2009 and 2014 received BM (n = 481) or PB (n = 190) grafts. Cox regression models were built to examine differences in transplant outcomes by graft type, adjusting for patient, disease, and transplant characteristics. Results Hematopoietic recovery was similar after transplantation of BM and PB (28-day neutrophil recovery, 88% v 93%, P = .07; 100-day platelet recovery, 88% v 85%, P = .33). Risks of grade 2 to 4 acute (hazard ratio [HR], 0.45; P < .001) and chronic (HR, 0.35; P < .001) graft-versus-host disease were lower with transplantation of BM compared with PB. There were no significant differences in overall survival by graft type (HR, 0.99; P = .98), with rates of 54% and 57% at 2 years after transplantation of BM and PB, respectively. There were no differences in nonrelapse mortality risks (HR, 0.92; P = .74) but relapse risks were higher after transplantation of BM (HR, 1.49; P = .009). Additional exploration confirmed that the higher relapse risks after transplantation of BM were limited to patients with leukemia (HR, 1.73; P = .002) and not lymphoma (HR, 0.87; P = .64). Conclusion PB and BM grafts are suitable for haploidentical transplantation with the post-transplant cyclophosphamide approach but with differing patterns of treatment failure. Although, to our knowledge, this is the most comprehensive comparison, these findings must be validated in a randomized prospective comparison with adequate follow-up.

PubMed ID

28644773

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