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09.07.2018 | Original Article

Haplo-identical allografting with post-transplant cyclophosphamide in high-risk patients

verfasst von: Lucia Brunello, Roberto Passera, Chiara Maria Dellacasa, Luisa Giaccone, Ernesta Audisio, Dario Ferrero, Stefano D’Ardia, Bernardino Allione, Semra Aydin, Moreno Festuccia, Giuseppe Lia, Elena Crisà, Enrico Maffini, Sara Butera, Alessandro Busca, Benedetto Bruno

Erschienen in: Annals of Hematology | Ausgabe 11/2018

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Abstract

Haplo-identical transplants (Haplo-Tx) are an important alternative for patients with hematological malignancies who lack a HLA-identical donor. Seventy-one T-replete Haplo-Tx were performed in 70 high-risk patients at our center; 22/70 (31%) patients with refractory/relapsed leukemia received sequential salvage therapy (SeqTh) with high-dose chemotherapy followed by Haplo-Tx during the chemotherapy-induced neutropenia. Graft-versus-host disease (GVHD) prophylaxis consisted of post-transplant cyclophosphamide (days + 3 and + 4) with tacrolimus and mycophenolic acid. After a median follow-up of 29.2 months, 3-year overall survival (OS) and event-free survival (EFS) were 43.8 and 40.2%, while 3-year cumulative incidences (CIs) of non-relapse mortality (NRM) and relapse (RI) were 27 and 33%. Day 100 and day 400 CI of grade III–IV acute and moderate-severe chronic GVHD were 11 and 15%. Three-year RI was significantly lower in patients in complete remission (CR) versus those not in CR at the time of transplant (21.5 vs. 48%, p = 0.009) and in patients who received PBSC as compared to BM (22 vs. 45%, p = 0.009). In patients treated with SeqTh, 3-year OS was 19%, while 3-year RI and NRM were 52 and 28% at a median follow-up of 50 months. Overall, Haplo-Tx was feasible in heavily pretreated high-risk patients without a suitable HLA-identical donor.

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Titel: Haplo-identical allografting with post-transplant cyclophosphamide in high-risk patients
verfasst von: Lucia Brunello
Roberto Passera
Chiara Maria Dellacasa
Luisa Giaccone
Ernesta Audisio
Dario Ferrero
Stefano D’Ardia
Bernardino Allione
Semra Aydin
Moreno Festuccia
Giuseppe Lia
Elena Crisà
Enrico Maffini
Sara Butera
Alessandro Busca
Benedetto Bruno
Publikationsdatum: 09.07.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: Annals of Hematology / Ausgabe 11/2018
Print ISSN: 0939-5555
Elektronische ISSN: 1432-0584
DOI: https://doi.org/10.1007/s00277-018-3433-3

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Haplo-identical allografting with post-transplant cyclophosphamide in high-risk patients

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