Clinical Hematology International

Volume 1, Issue 2, June 2019, Pages 105 - 113

Safety and Efficacy of Haploidentical Peripheral Blood Stem Cell Transplantation for Myeloid Malignancies Using Post-transplantation Cyclophosphamide and Anti-thymocyte Globulin as Graft-versus-Host Disease Prophylaxis

Authors
Maria Queralt Salas, Arjun Datt Law, Wilson Lam, Zeyad Al-Shaibani, David Loach, Dennis (Dong Hwan) Kim, Fotios V. Michelis, Santhosh Thyagu, Rajat Kumar, Jeffrey Howard Lipton, Jonas Mattsson, Auro Viswabandya*
Hans Messner Allogeneic Blood and Marrow Transplant Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada

Contributed equally to this publication

*Corresponding author. Email: auro.viswabandya@uhn.ca
Corresponding Author
Auro Viswabandya
Received 18 February 2019, Accepted 8 March 2019, Available Online 11 June 2019.
DOI
10.2991/chi.d.190316.003How to use a DOI?
Keywords
Haploidentical hematopoietic cell transplantation; T-cell replete grafts; Post-transplant cyclophosphamide; Anti-thymocyte globulin; Myeloid malignancies; Graft-versus-host disease
Abstract

Haploidentical stem cell transplantation (haploSCT) has greatly improved access to curative treatment for myeloid malignancies in patients without suitable matched sibling/unrelated donors. We investigated the safety and efficacy of haploSCT after reduced intensity conditioning (RIC) with anti-thymocyte globulin (ATG), post-transplant cyclophosphamide (PTCy), and cyclosporine to prevent rejection and graft-versus-host disease (GVHD). In this study, 47 patients received RIC using fludarabine, busulfan, and total body irradiation (200 cGy). Unmanipulated peripheral blood grafts were used. GVHD prophylaxis included ATG (4.5 mg/kg day−3 to −1), PTCy (50 mg/kg/day day +3, +4), and cyclosporine from day +5. The median follow-up was 15 months (range 3–27). Thirty one (66%) patients had acute myeloid leukemia (AML), 10 (21%) had high-risk myelodysplastic syndrome, and 6 (13%) had a myeloproliferative neoplasia. Median age was 60 years (range 22–73). The d+100 cumulative incidences of grade II–IV and III–IV acute GVHD were 17% (95% confidence interval (CI) 7.9–29.1) and 6.4% (1.6–15.9), respectively. The cumulative incidence of moderate-severe chronic GVHD at 1 year was 15.2% (95% CI 6.5–27.1). Overall survival (OS) and relapse-free survival (RFS) were 55.2% (95% CI 39.5–68.4) and 49.5% (95% CI 34.2–63), respectively. Nonrelapse mortality (NRM) for all patients at 1 year was 37.1% (95% CI 23.2–51.1). Infection was the main cause of death (26%). For AML, 1-year OS, RFS, and NRM were 64.1% (95% CI 43.3–78.9), 54.5 (95% CI 34.6–70.7), and 26.8% (95% CI 12.3–43.6), respectively. In conclusion, unmanipulated haploidentical peripheral blood stem cells (PBSC) transplantation following RIC and dual in vivo T-cell depletion results in a low incidence of acute and chronic GVHD for patients diagnosed with myeloid malignancies.

Copyright
© 2019 International Academy for Clinical Hematology. Publishing services by Atlantis Press International B.V.
Open Access
This is an open access article distributed under the CC BY-NC 4.0 license (http://creativecommons.org/licenses/by-nc/4.0/).

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Journal
Clinical Hematology International
Volume-Issue
1 - 2
Pages
105 - 113
Publication Date
2019/06/11
ISSN (Online)
2590-0048
DOI
10.2991/chi.d.190316.003How to use a DOI?
Copyright
© 2019 International Academy for Clinical Hematology. Publishing services by Atlantis Press International B.V.
Open Access
This is an open access article distributed under the CC BY-NC 4.0 license (http://creativecommons.org/licenses/by-nc/4.0/).

Cite this article

TY  - JOUR
AU  - Maria Queralt Salas
AU  - Arjun Datt Law
AU  - Wilson Lam
AU  - Zeyad Al-Shaibani
AU  - David Loach
AU  - Dennis (Dong Hwan) Kim
AU  - Fotios V. Michelis
AU  - Santhosh Thyagu
AU  - Rajat Kumar
AU  - Jeffrey Howard Lipton
AU  - Jonas Mattsson
AU  - Auro Viswabandya
PY  - 2019
DA  - 2019/06/11
TI  - Safety and Efficacy of Haploidentical Peripheral Blood Stem Cell Transplantation for Myeloid Malignancies Using Post-transplantation Cyclophosphamide and Anti-thymocyte Globulin as Graft-versus-Host Disease Prophylaxis
JO  - Clinical Hematology International
SP  - 105
EP  - 113
VL  - 1
IS  - 2
SN  - 2590-0048
UR  - https://doi.org/10.2991/chi.d.190316.003
DO  - 10.2991/chi.d.190316.003
ID  - Salas2019
ER  -