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Comparable outcomes with marrow or peripheral blood as stem cell sources for hematopoietic cell transplantation from haploidentical donors after non-ablative conditioning: a matched-pair analysis

Bone Marrow Transplantation volume 51, pages 1599–1601 (2016)Cite this article

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In the setting of myeloablative conditioning and conventional post-grafting immunoprophylaxis for GvHD with a calcineurin inhibitor and methotrexate, randomized studies of bone marrow (BM) vs peripheral blood (PB) as the allograft source in transplantation from HLA-matched related donors1 or unrelated donors2 showed comparable outcomes with the exception of an absolute increase of 6–15% in the incidence of chronic GvHD after transplantation of PB. However, in the setting of non-ablative conditioning, a recent retrospective study from the Center for International Blood and Marrow Transplant Research (CIBMTR) showed that rates of acute GvHD, chronic GvHD and overall survival were similar after transplantation of BM compared with PB.3 To test whether outcomes were similar after haplo-BM and haplo-PB transplants using non-ablative conditioning with the Hopkins regimen,4 we compared data from a multi-center phase II trial of haplo-BM conducted in the US (Blood and Marrow Transplant Clinical Trials Network (BMT CTN) 06035, 6) with published and unpublished data from phase II trials of haplo-PB transplants in the US, Europe and Australia7, 8, 9 by means of a matched-pair analysis. Patients 70 years of age or younger who met the eligibility criteria for BMT CTN 0603 were matched for age±10 years and for low-intermediate-high disease risk index (DRI). DRI is a composite of disease, disease status and cytogenetic risk (acute leukemia and myelodysplastic syndrome) that has been shown to independently risk stratify survival in heterogeneous adult patient cohorts with hematologic malignancy regardless of conditioning intensity or graft source.10

Patient, disease and transplant characteristics of the cohorts are shown in Table 1. The median age at transplantation was 49 years. Recipients of haplo-PB transplants were more likely to report three or more significant co-morbidities using the hematopoietic cell transplant co-morbidity index score compared with haplo-BM transplants (47 vs 28%). As shown in Table 1 there were differences in the distribution of diseases transplanted and disease status at transplantation. However, ~75% of patients in both cohorts were assigned intermediate DRI. Follow-up was substantially longer in the haplo-BM compared with haplo-PB cohort (median 60 months vs 39 months, respectively). Of the 19 patients alive at last follow-up after haplo-BM transplant, 17 (89%) have over 3 years of follow-up and the remaining 2 patients, 30 and 32 months; among haplo-PB recipients, 18 of 29 patients (62%) have over 3 years of follow-up, 6 patients (21%) and 5 patients (17%) have been followed for 2–3 years and 1–2 years, respectively.

Table 1 Patient and disease characteristics
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Acknowledgements

This research was supported, in part, by grants U01-HL069294 from the National Heart, Lung and Blood Institute and the National Cancer Institute, U24-CA76518 from the National Heart, Lung and Blood Institute, the National Cancer Institute and the National Institute of Allergy and Infectious Diseases, CA 18029 from the National Cancer Institute and LLR Funding.

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Authors and Affiliations

  1. Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    P V O'Donnell, M E D Flowers & R Salit

  2. Massachusetts General Hospital Cancer Center, Boston, MA, USA

    P V O'Donnell

  3. Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA

    M Eapen, M M Horowitz, B R Logan & A DiGilio

  4. Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN, USA

    C Brunstein

  5. Sydney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA

    E J Fuchs

  6. Guy’s and St. Thomas’ Hospitals NHS Hospitals Foundation Trusts, London, UK

    K Raj

  7. Department of Haematological Medicine, King’s College Hospital, London, UK

    K Raj & A Pagliuca

  8. Department of Hematology, Westmead Hospital, Westmead, New South Wales, Australia

    K Bradstock

  9. Department of Hematology, Institut Paoli Calmettes (IPC), Aix Marseille University (AMU), UM105, Centre de Reserche en Cancerologie (CRCM), Inserm U1068, CNRS UMR7258, Marseille, France

    A Granata, S Furst & D Blaise

  10. Department of Hematology, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy

    L Castagna

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Correspondence to P V O'Donnell.

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O'Donnell, P., Eapen, M., Horowitz, M. et al. Comparable outcomes with marrow or peripheral blood as stem cell sources for hematopoietic cell transplantation from haploidentical donors after non-ablative conditioning: a matched-pair analysis. Bone Marrow Transplant 51, 1599–1601 (2016). https://doi.org/10.1038/bmt.2016.215

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