Adults transplanted for advanced or poor-risk hematologic malignancies can have comparable outcomes using haploidentical, related donor, or unrelated donor grafts when high-dose post-transplant cyclophosphamide is administered to reduce graft-versus-host-disease (GVHD), according to study results presented at ASH. In this retrospective study of 582 consecutive adults transplanted at Johns Hopkins University between 2002 and 2012, all patients received T-cell-replete bone marrow grafts. Haploidentical recipients received non-myeloablative conditioning regimens, and related and unrelated donor recipients received myeloablative conditioning. Median patient age at time of transplant was 54 years (range 18-73) in the non-myeloablative cohort and 49 years (range 18-66) in the myeloablative cohorts (p=0.001). Three-year overall survival was 49%, 58%, and 56% for haploidentical, matched related donor, and matched unrelated donor transplants, respectively (p=n.s.). Lead researcher Dr. Shannon McCurdy noted that three-year estimates of chronic GVHD-free relapse-free survival approached the estimates of disease-free survival, and that therefore the addition of high-dose post-transplant cyclophosphamide may be acting to minimize the late morbidity and mortality of chronic GVHD.
Post-Transplant Cyclophosphamide Yields Comparable Outcomes Across Donor Types and Conditioning Regimens