Comparable Outcomes in Unrelated Donor vs. Haploidentical HCT with Cyclophosphamide

Lower-intensity hematopoietic cell transplantation (HCT) using haploidentical donors and post-transplant cyclophosphamide for GVHD prophylaxis can achieve outcomes comparable to HLA-matched unrelated donor transplants, according to results of a retrospective study of 917 adults with Hodgkin or Non-Hodgkin lymphoma. All patients in the multi-center study underwent HCT between 2008 and 2013, and were separated into three groups: haploidentical (n=185), 8/8 unrelated donor (UD) without ATG (n=491), and 8/8 UD with ATG (n=241). GVHD prophylaxis in the haploidentical cohort was cyclophosphamide plus a calcineurin inhibitor (CNI) and mycophenolate; the UD cohort received CNI-based GVHD prophylaxis.

Median age in all cohorts was 55 years (range, 18-75), and the median follow up was 35 months (range, <1-75). The 3-year overall survival (OS) among the haploidentical, UD without ATG, and UD with ATG cohorts were comparable: 60%, 62%, and 50%, respectively (p>0.05).

The researchers noted that although chronic GVHD was significantly lower with haploidentical HCT, relapse was high. They therefore concluded that prospective randomized trials with longer follow-up periods are needed to confirm the results of this retrospective study before widespread adoption of haploidentical HCT over matched UD transplantation for patients with lymphoma.

Mussetti A, et al. Blood

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