Reduced-intensity HCT using haploidentical or matched unrelated donors (URD) yields comparable outcomes, according to a study of 917 adults transplanted for lymphoma. Haploidentical transplant recipients (n=185) received post-transplant cyclophosphamide for GVHD prophylaxis. All 732 URD recipients received calcineurin inhibitors as GVHD prophylaxis; 241 received antithymocyte globulin (ATG) and 491 did not. Three-year relapse/progression was 36%, 28%, and 36% in the haploidentical, URD without ATG, and URD with ATG groups, respectively (p=0.07). Three-year overall survival was 60%, 62%, and 50% in the 3 groups, respectively (p>0.05). Cumulative incidence of grade III-IV chronic GVHD was significantly lower for haploidentical recipients compared to URD recipients, with and without ATG (overall p<0.001 at 1 year and 2 years). BMT CTN trials 1301 and 1203 are evaluating the impact of the post-transplant cyclophosphamide for GVHD prophylaxis relative to the standard CNI-based prophylaxis. The authors conclude that reduced-intensity HCT using haploidentical or matched URD yields comparable early survival outcomes in lymphoma patients, but confirmation is needed in long-term, prospective studies.
Haploidentical, Unrelated Donor HCT Outcomes Comparable in Lymphoma