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  • Review Article
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Considerations for haploidentical versus unrelated donor transplants

Abstract

Haploidentical transplantation is increasingly performed worldwide due to novel methods to control alloreactivity between the donor and recipient. This major advancement has increased donor availability to almost all patients in need. Outcomes with haploidenitcal donors have also improved and prompted many groups to compare outcomes between haploidentical and HLA-matched donor transplants. In this review, we provide a summary of available data on haploidentical transplants performed with post transplant cyclophosphamide-based graft-versus-host disease (GVHD) prophylaxis and HLA-matched unrelated donor transplants.

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References

  1. Gratwohl A, Pasquini MC, Aljurf M, Atsuta Y, Baldomero H, Foeken L, et al. One million haemopoietic stem-cell transplants: a retrospective observational study. Lancet Haematol 2015;2:e91–100.

    Article  Google Scholar 

  2. Passweg JR, Baldomero H, Bader P, Bonini C, Duarte RF, Dufour C, et al. Use of haploidentical stem cell transplantation continues to increase: the 2015 European Society for Blood and Marrow Transplant activity survey report. Bone Marrow Transplant. 2017;52:811–7.

    Article  CAS  Google Scholar 

  3. Passweg JR, Baldomero H, Bader P, Bonini C, Cesaro S, Dreger P, et al. Hematopoietic stem cell transplantation in Europe 2014: more than 40 000 transplants annually. Bone Marrow Transplant. 2016;51:786–92.

    Article  CAS  Google Scholar 

  4. Ballen KK, King RJ, Chitphakdithai P, Bolan CD Jr., Agura E, Hartzman RJ, et al. The national marrow donor program 20 years of unrelated donor hematopoietic cell transplantation. Biol Blood Marrow Transplant: J Am Soc Blood Marrow Transplant. 2008;14(9 Suppl):2–7.

    Article  Google Scholar 

  5. Segal E, Martens M, Wang HL, Brazauskas R, Weisdorf D, Sandmaier BM, et al. Comparing outcomes of matched related donor and matched unrelated donor hematopoietic cell transplants in adults with B-cell acute lymphoblastic leukemia. Cancer 2017;123:3346–55.

    Article  CAS  Google Scholar 

  6. Saber W, Opie S, Rizzo JD, Zhang MJ, Horowitz MM, Schriber J. Outcomes after matched unrelated donor versus identical sibling hematopoietic cell transplantation in adults with acute myelogenous leukemia. Blood 2012;119:3908–16.

    Article  CAS  Google Scholar 

  7. Appelbaum FR. Allogeneic hematopoietic cell transplantation for acute myeloid leukemia when a matched related donor is not available. Hematol Am Soc Hemat. 2008;2008:412–7. https://doi.org/10.1182/asheducation-2008.1.412.

  8. Brissot E, Labopin M, Stelljes M, Ehninger G, Schwerdtfeger R, Finke J, et al. Comparison of matched sibling donors versus unrelated donors in allogeneic stem cell transplantation for primary refractory acute myeloid leukemia: a study on behalf of the Acute Leukemia Working Party of the EBMT. J Hematol Oncol. 2017;10:130.

    Article  Google Scholar 

  9. National Marrow Donor Program, a contractor for the C.W. Bill Young Cell Transplantation Program operated through the U. S. Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Donor Registry Data 2017 [updated 10 March 2017]. Available from: https://bloodcell.transplant.hrsa.gov/research/registry_donor_data/index.html

  10. Krupski MC, Perentesis EMR, Sper C, Bonavita A, Fohl D, Davies SM. How long does it take to find a matched unrelated donor in 2016? Biol Blood Marrow Transplant. 2017;23:S238–9.

    Article  Google Scholar 

  11. van Agthoven M, Groot MT, Verdonck LF, Lowenberg B, Schattenberg AV, Oudshoorn M, et al. Cost analysis of HLA-identical sibling and voluntary unrelated allogeneic bone marrow and peripheral blood stem cell transplantation in adults with acute myelocytic leukaemia or acute lymphoblastic leukaemia. Bone Marrow Transplant 2002;30:243–51.

    Article  Google Scholar 

  12. Kongtim P, Lee DA, Cooper LJ, Kebriaei P, Champlin RE, Ciurea SO. Haploidentical hematopoietic stem cell transplantation as a platform for post-transplantation cellular therapy. Biol Blood Marrow Transplant: J Am Soc Blood Marrow Transplant. 2015;21:1714–20.

    Article  Google Scholar 

  13. Ciurea SO, Zhang MJ, Bacigalupo AA, Bashey A, Appelbaum FR, Aljitawi OS, et al. Haploidentical transplant with posttransplant cyclophosphamide vs matched unrelated donor transplant for acute myeloid leukemia. Blood 2015;126:1033–40.

    Article  CAS  Google Scholar 

  14. Kanate AS, Mussetti A, Kharfan-Dabaja MA, Ahn KW, DiGilio A, Beitinjaneh A, et al. Reduced-intensity transplantation for lymphomas using haploidentical related donors vs HLA-matched unrelated donors. Blood 2016;127:938–47.

    Article  CAS  Google Scholar 

  15. Martinez C, Gayoso J, Canals C, Finel H, Peggs K, Dominietto A, et al. Post-transplantation cyclophosphamide-based haploidentical transplantation as alternative to matched sibling or unrelated donor transplantation for hodgkin lymphoma: a registry study of the Lymphoma Working Party of the European Society for Blood and Marrow Transplantation. J Clin Oncol: Off J Am Soc Clin Oncol 2017;35:3425–32.

    Article  CAS  Google Scholar 

  16. Gu Z, Wang L, Yuan L, Huang W, Li M, Guan L, et al. Similar outcomes after haploidentical transplantation with post-transplant cyclophosphamide versus HLA-matched transplantation: a meta-analysis of case-control studies. Oncotarget 2017;8:63574–86.

    PubMed  PubMed Central  Google Scholar 

  17. Di Stasi A, Milton DR, Poon LM, Hamdi A, Rondon G, Chen J, et al. Similar transplantation outcomes for acute myeloid leukemia and myelodysplastic syndrome patients with haploidentical versus 10/10 human leukocyte antigen-matched unrelated and related donors. Biol Blood Marrow Transplant: J Am Soc Blood Marrow Transplant. 2014;20:1975–81.

    Article  Google Scholar 

  18. Brunstein CG, Fuchs EJ, Carter SL, Karanes C, Costa LJ, Wu J, et al. Alternative donor transplantation after reduced intensity conditioning: results of parallel phase 2 trials using partially HLA-mismatched related bone marrow or unrelated double umbilical cord blood grafts. Blood 2011;118:282–8.

    Article  CAS  Google Scholar 

  19. Gaballa S, Ge I, El Fakih R, Brammer JE, Kongtim P, Tomuleasa C, et al. Results of a 2-arm, phase 2 clinical trial using post-transplantation cyclophosphamide for the prevention of graft-versus-host disease in haploidentical donor and mismatched unrelated donor hematopoietic stem cell transplantation. Cancer 2016;122:3316–26.

    Article  CAS  Google Scholar 

  20. Solomon SR, Sizemore CA, Sanacore M, Zhang X, Brown S, Holland HK, et al. Haploidentical transplantation using T cell replete peripheral blood stem cells and myeloablative conditioning in patients with high-risk hematologic malignancies who lack conventional donors is well tolerated and produces excellent relapse-free survival: results of a prospective phase II trial. Biol Blood Marrow Transplant: J Am Soc Blood Marrow Transplant. 2012;18:1859–66.

    Article  Google Scholar 

  21. Luznik L, Bolanos-Meade J, Zahurak M, Chen AR, Smith BD, Brodsky R, et al. High-dose cyclophosphamide as single-agent, short-course prophylaxis of graft-versus-host disease. Blood 2010;115:3224–30.

    Article  CAS  Google Scholar 

  22. Kanakry CG, O’Donnell PV, Furlong T, de Lima MJ, Wei W, Medeot M, et al. Multi-institutional study of post-transplantation cyclophosphamide as single-agent graft-versus-host disease prophylaxis after allogeneic bone marrow transplantation using myeloablative busulfan and fludarabine conditioning. J Clin Oncol: Off J Am Soc Clin Oncol. 2014;32:3497–505.

    Article  CAS  Google Scholar 

  23. Mielcarek M, Furlong T, O’Donnell PV, Storer BE, McCune JS, Storb R, et al. Posttransplantation cyclophosphamide for prevention of graft-versus-host disease after HLA-matched mobilized blood cell transplantation. Blood 2016;127:1502–8.

    Article  CAS  Google Scholar 

  24. Shah MV, Saliba RM, Rondon G, Chen J, Soebbing D, Rus I, et al. Pilot study using post-transplant cyclophosphamide (PTCy), tacrolimus and mycophenolate GVHD prophylaxis for older patients receiving 10/10 HLA-matched unrelated donor hematopoietic stem cell transplantation. Bone Marrow Transplant. 2019;54:601–6.

    Article  CAS  Google Scholar 

  25. Burroughs LM, O’Donnell PV, Sandmaier BM, Storer BE, Luznik L, Symons HJ, et al. Comparison of outcomes of HLA-matched related, unrelated, or HLA-haploidentical related hematopoietic cell transplantation following nonmyeloablative conditioning for relapsed or refractory Hodgkin lymphoma. Biol Blood Marrow Transplant: J Am Soc Blood Marrow Transplant. 2008;14:1279–87.

    Article  Google Scholar 

  26. Bashey A, Zhang X, Sizemore CA, Manion K, Brown S, Holland HK, et al. T-cell-replete HLA-haploidentical hematopoietic transplantation for hematologic malignancies using post-transplantation cyclophosphamide results in outcomes equivalent to those of contemporaneous HLA-matched related and unrelated donor transplantation. J Clin Oncol: Off J Am Soc Clin Oncol. 2013;31:1310–6.

    Article  CAS  Google Scholar 

  27. Raiola AM, Dominietto A, di Grazia C, Lamparelli T, Gualandi F, Ibatici A, et al. Unmanipulated haploidentical transplants compared with other alternative donors and matched sibling grafts. Biol Blood Marrow Transplant: J Am Soc Blood Marrow Transplant. 2014;20:1573–9.

    Article  Google Scholar 

  28. Blaise D, Furst S, Crocchiolo R, El-Cheikh J, Granata A, Harbi S, et al. Haploidentical T cell-replete transplantation with post-transplantation cyclophosphamide for patients in or above the sixth decade of age compared with allogeneic hematopoietic stem cell transplantation from an human leukocyte antigen-matched related or unrelated donor. Biol Blood Marrow Transplant: J Am Soc Blood Marrow Transplant. 2016;22:119–24.

    Article  Google Scholar 

  29. Baker M, Wang H, Rowley SD, Cai L, Pecora AL, Skarbnik A, et al. Comparative Outcomes after Haploidentical or Unrelated Donor Bone Marrow or Blood Stem Cell Transplantation in Adult Patients with Hematological Malignancies. Biol Blood Marrow Transplant. 2016;22:2047–55. https://doi.org/10.1016/j.bbmt.2016.08.003

  30. Rashidi A, DiPersio JF, Westervelt P, Vij R, Schroeder MA, Cashen AF, et al. Comparison of outcomes after peripheral blood haploidentical versus matched unrelated donor allogeneic hematopoietic cell transplantation in patients with acute myeloid leukemia: a retrospective single-center review. Biol Blood Marrow Transplant: J Am Soc Blood Marrow Transplant. 2016;22:1696–701.

    Article  Google Scholar 

  31. McCurdy SR, Kasamon YL, Kanakry CG, Bolanos-Meade J, Tsai HL, Showel MM, et al. Comparable composite endpoints after HLA-matched and HLA-haploidentical transplantation with post-transplantation cyclophosphamide. Haematologica 2017;102:391–400.

    Article  CAS  Google Scholar 

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Funding

Publication of this supplement was sponsored by Gilead Sciences Europe Ltd, Cell Source, Inc., The Chorafas Institute for Scientific Exchange of the Weizmann Institute of Science, Kiadis Pharma, Miltenyi Biotec, Celgene, Centro Servizi Congressuali, Almog Diagnostic.

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Correspondence to Stefan O. Ciurea.

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Ciurea, S.O. Considerations for haploidentical versus unrelated donor transplants. Bone Marrow Transplant 54 (Suppl 2), 738–742 (2019). https://doi.org/10.1038/s41409-019-0613-2

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