Three-Year Outcomes in Recipients of Mismatched Unrelated Bone Marrow Donor Transplants Using Post-Transplantation Cyclophosphamide: Follow-Up from a National Marrow Donor Program-Sponsored Prospective Clinical Trial

Bronwen E. Shaw, Antonio Martin Jimenez-Jimenez, Linda J. Burns, Brent R. Logan, Farhad Khimani, Brian C. Shaffer, Nirav N. Shah, Alisha Mussetter, Xiao Ying Tang, John M. McCarty, Asif Alavi, Nosha Farhadfar, Katarzyna Jamieson, Nancy M. Hardy, Hannah Choe, Richard F. Ambinder, Claudio Anasetti, Miguel Angel Perales, Stephen R. Spellman, Alan HowardKrishna V. Komanduri, Leo Luznik, Maxim Norkin, Joseph A. Pidala, Voravit Ratanatharathorn, Dennis L. Confer, Steven M. Devine, Mary M. Horowitz, Javier Bolaños-Meade

Research output: Contribution to journalArticlepeer-review

Abstract

The use of post-transplantation cyclophosphamide (PTCy) as graft-versus-host disease (GVHD) prophylaxis has resulted in reductions in GVHD and improved outcomes in allogeneic hematopoietic cell transplantation (HCT) using HLA-mismatched related donors. We report the 3-year outcomes of the first multicenter prospective clinical trial using PTCy in the setting of mismatched unrelated donor (MMUD) bone marrow HCT. The study enrolled 80 patients, treated with either myeloablative conditioning (MAC; n = 40) or reduced-intensity conditioning (RIC; n = 40), with the primary endpoint of 1-year overall survival (OS). The median follow-up for this study was 34 months (range, 12 to 46 months) in the RIC group and 36 months (range, 18 to 49 months) in the MAC group. Three-year OS and nonrelapse mortality were 70% and 15%, respectively, in the RIC group and 62% and 10% in the MAC group. No GVHD was reported after 1 year. The incidence of relapse was 29% in the RIC group and 51% in the MAC group. OS did not differ based on HLA match grade (63% in the 7/8 strata and 71% in the 4 to 6/8 strata). These encouraging outcomes, which were sustained for 3 years post-HCT, support the continued exploration of MMUD HCT using a PTCy platform. Important future areas to address include relapse reduction and furthering our understanding of optimal donor selection based on HLA and non-HLA factors.

Original languageEnglish (US)
Pages (from-to)208.e1-208.e6
JournalTransplantation and Cellular Therapy
Volume29
Issue number3
DOIs
StatePublished - Mar 2023

Keywords

  • HLA
  • Hematopoietic cell transplant
  • Mismatched unrelated donor
  • Post transplant cyclophosphamide

ASJC Scopus subject areas

  • Transplantation
  • Molecular Medicine
  • Hematology
  • Immunology and Allergy
  • Cell Biology

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