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Impact of second-degree related donor on the outcomes of T cell-replete haploidentical transplantation with post-transplant cyclophosphamide

Abstract

Donor selection may contribute to improve clinical outcomes of T cell-replete haploidentical stem cell transplantation (Haplo-SCT) with post-transplant cyclophosphamide (PT-Cy). Impact of second-degree related donor (SRD) was not fully elucidated in this platform. We retrospectively compared the outcome of patients receiving Haplo-SCT either from a SRD (n = 31) or a first-degree related donor (FRD, n = 957). Median time to neutrophil and platelet recovery did not differ between a SRD and a FRD transplant (p = 0.599 and 0.587). Cumulative incidence of grade II–IV acute graft-versus host disease (GVHD) and moderate-severe chronic GVHD was 13% and 19% after SRD vs 24% (p = 0.126) and 13% (p = 0.395) after FRD transplant. One-year cumulative incidence of non-relapse mortality (NRM) was 19% for SRD and 20% for FRD (p = 0.435) cohort. The 3-year probability of overall survival (OS) and progression-free survival (PFS) was 42% vs 55% (p = 0.273) and 49% vs 35% (p = 0.280) after SRD and FRD transplant, respectively. After propensity score adjustment or matched pair analysis, the outcome of patients receiving Haplo-SCT from a SRD or a FRD did not differ in terms of NRM, OS, PFS, acute and chronic GVHD. Our results suggest that a SRD is a viable option for Haplo-SCT with PT-Cy when a FRD is not available.

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Fig. 1: Engraftment and GVHD rate.
Fig. 2: Infections after first degree and second-degree related donot tranplant.
Fig. 3: Outcomr of patients receiving first-degree or second-degree related donor transplant.

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Acknowledgements

This work was supported by the following funding: Fondazione Cariplo 2015/0603 (DM and BB) Associazione Italiana per la Ricerca sul Cancro IG21567, and Intramural Research Funding of Istituto Clinico Humanitas (5*1000 project) (DM and LC).

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JM performed research, analyzed and interpreted data, wrote the paper; AMR collected data and provided data interpretation; AE provided data analysis and interpretation; MAC, MM, FP, AR collected data and supervised the paper; AB, LG, LB, BL, GC, RF, AS, LM, SM, CF, SS, PC collected data; AB, DB, provided data interpretation and revised the paper; SB designed research; DM, EA, LC, and BB designed research, provided data interpretation, and supervised paper writing.

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Correspondence to Stefania Bramanti.

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Mariotti, J., Raiola, A.M., Evangelista, A. et al. Impact of second-degree related donor on the outcomes of T cell-replete haploidentical transplantation with post-transplant cyclophosphamide. Bone Marrow Transplant 57, 1758–1764 (2022). https://doi.org/10.1038/s41409-022-01565-1

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