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Against the odds: haplo-cord grafts protect from GvHD and relapse

Bone Marrow Transplantation volume 52, pages 1590–1591 (2017)Cite this article

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Two competing technologies, haplo-identical transplantation and umbilical cord blood transplantation offer curative treatments for malignant and non-malignant hematologic conditions in patients who lack HLA-identical donors. The choice between the two approaches is mostly driven by comparison of long-term cure rates and frequency of complications. But short-term factors such as ease of implementation, procedural cost and duration of initial admission also affect centers’ choices. Haplo-identical transplantation with post-transplant cyclophosphamide (PTCy-haplo) for graft versus host disease (GvHD) prophylaxis has garnered considerable interest.1, 2 Most patients have haplo-identical family donors. The procedure is straightforward, can be readily implemented and engraftment is relatively fast compared to commonly used single or double umbilical cord blood (UCB) transplantation. Haplo-cord transplantation, the co-infusion of a cord blood graft with CD34-selected cells from a haploidentical related or unrelated donor obviates the prolonged pancytopenia and lengthy initial hospitalizations associated with UCB transplant.3 But the CD34 selection of the haplo-graft and the purchase of a cord blood graft pose financial and technical barriers to implementation.

Kwon et al.1 are the first to conduct a comparison of the outcomes of haplo-cord transplantation versus haplo-identical transplantation with post-transplant cyclophosphamide. They find similar long-term survival, progression-free survival, non-relapse mortality (NRM) and rates of disease progression. But the comparison is retrospective and the groups are unevenly poised with most imbalances favoring the PTCy-haplo cohort.

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  1. Department of Hematology and Medical Oncology, Weill Cornell Medicine, 520 East 70th Street, New York, NY, USA

    H K Choe & K van Besien

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  1. H K Choe
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Correspondence to K van Besien.

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Choe, H., van Besien, K. Against the odds: haplo-cord grafts protect from GvHD and relapse. Bone Marrow Transplant 52, 1590–1591 (2017). https://doi.org/10.1038/bmt.2017.102

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