Journal
BLOOD
Volume 127, Issue 7, Pages 938-947Publisher
AMER SOC HEMATOLOGY
DOI: 10.1182/blood-2015-09-671834
Keywords
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Categories
Funding
- Public Health Service Grant/Cooperative Agreement from the National Institutes of Health National Cancer Institute (NCI) [U24-CA076518]
- National Heart, Lung and Blood Institute (NHLBI)
- National Institute of Allergy and Infectious Diseases
- NHLBI [5U10HL069294]
- NCI
- Health Resources and Services Administration (HRSA/US Department of Health and Human Services [DHHS]) [HHSH250201200016C]
- Office of Naval Research [N00014-13-1-0039, N00014-14-1-0028]
- Actinium Pharmaceuticals
- Allos Therapeutics, Inc
- Amgen, Inc
- Ariad
- Be the Match Foundation
- Blue Cross and Blue Shield Association
- Celgene Corporation
- Chimerix, Inc
- Fred Hutchinson Cancer Research Center
- Fresenius-Biotech North America, Inc
- Gamida Cell Teva Joint Venture Ltd
- Genentech, Inc
- Gentium SpA
- Genzyme Corporation
- GlaxoSmithKline
- Health Research, Inc Roswell Park Cancer Institute
- HistoGenetics, Inc
- Incyte Corporation
- Jeff Gordon Children's Foundation
- Kiadis Pharma
- Leukemia & Lymphoma Society
- Medac GmbH
- Medical College of Wisconsin
- Merck Co, Inc
- Millennium: The Takeda Oncology Co
- Milliman USA, Inc
- Miltenyi Biotec, Inc
- National Marrow Donor Program
- Onyx Pharmaceuticals
- Optum Healthcare Solutions, Inc
- Osiris Therapeutics, Inc
- Otsuka America Pharmaceutical, Inc
- Perkin Elmer, Inc
- Remedy Informatics
- Sanofi US
- Seattle Genetics
- Sigma-Tau Pharmaceuticals
- Soligenix, Inc
- St. Baldrick's Foundation
- StemCyte, a Global Cord Blood Therapeutics Co
- Stemsoft Software, Inc
- Swedish Orphan Biovitrum
- Tarix Pharmaceuticals
- TerumoBCT
- Teva Neuroscience, Inc
- THERAKOS, Inc
- University of Minnesota
- University of Utah
- Wellpoint, Inc
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We evaluated 917 adult lymphoma patients who received haploidentical (n = 185) or HLA-matched unrelated donor (URD) transplantation either with (n = 241) or without antithymocyte globulin (ATG; n = 491) following reduced-intensity conditioning regimens. Haploidentical recipients received posttransplant cyclophosphamide-based graft-versus-host disease (GVHD) prophylaxis, whereas URD recipients received calcineurin inhibitor-based prophylaxis. Median follow-up of survivors was 3 years. The 100-day cumulative incidence of grade III-IV acute GVHD on univariate analysis was 8%, 12%, and 17% in the haploidentical, URD without ATG, and URD with ATG groups, respectively (P = .44). Corresponding 1-year rates of chronic GVHD on univariate analysis were 13%, 51%, and 33%, respectively (P < .001). On multivariate analysis, grade III-IV acute GVHD was higher in URD without ATG (P = .001), as well as URD with ATG (P = .01), relative to haploidentical transplants. Similarly, relative to haploidentical transplants, risk of chronic GVHD was higher in URD without ATG and URD with ATG (P < .0001). Cumulative incidence of relapse/progression at 3 years was 36%, 28%, and 36% in the haploidentical, URD without ATG, and URD with ATG groups, respectively (P = .07). Corresponding 3-year overall survival (OS) was 60%, 62%, and 50% in the 3 groups, respectively, with multivariate analysis showing no survival difference between URD without ATG (P = .21) or URD with ATG (P = .16), relative to haploidentical transplants. Multivariate analysis showed no difference between the 3 groups in terms of nonrelapse mortality (NRM), relapse/progression, and progression-free survival (PFS). These data suggest that reduced-intensity conditioning haploidentical transplantation with posttransplant cyclophosphamide does not compromise early survival outcomes compared with matched URD transplantation, and is associated with significantly reduced risk of chronic GVHD.
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