TY - JOUR
T1 - Composite GRFS and CRFS Outcomes after Adult Alternative Donor HCT
AU - Mehta, Rohtesh S.
AU - Holtan, Shernan G.
AU - Wang, Tao
AU - Hemmer, Michael T.
AU - Spellman, Stephen R.
AU - Arora, Mukta
AU - Couriel, Daniel R.
AU - Alousi, Amin M.
AU - Pidala, Joseph
AU - Abdel Azim, Hisham
AU - Agrawal, Vaibhav
AU - Ahmed, Ibrahim
AU - Al-Homsi, A. Samer
AU - Aljurf, Mahmoud
AU - Antin, Joseph H.
AU - Askar, Medhat
AU - Auletta, Jeffery J.
AU - Bhatt, Vijaya Raj
AU - Chee, Lynette
AU - Chhabra, Saurabh
AU - Daly, Andrew
AU - DeFilipp, Zachariah
AU - Gajewski, James
AU - Gale, Robert Peter
AU - Gergis, Usama
AU - Hematti, Peiman
AU - Hildebrandt, Gerhard C.
AU - Hogan, William J.
AU - Inamoto, Yoshihiro
AU - Martino, Rodrigo
AU - Majhail, Navneet S.
AU - Marks, David I.
AU - Nishihori, Taiga
AU - Olsson, Richard F.
AU - Pawarode, Attaphol
AU - Diaz, Miguel Angel
AU - Prestidge, Tim
AU - Rangarajan, Hemalatha G.
AU - Ringden, Olle
AU - Saad, Ayman
AU - Savani, Bipin N.
AU - Schoemans, Hélène
AU - Seo, Sachiko
AU - Schultz, Kirk R.
AU - Solh, Melhem
AU - Spitzer, Thomas
AU - Storek, Jan
AU - Teshima, Takanori
AU - Verdonck, Leo F.
AU - Wirk, Baldeep
AU - Yared, Jean A.
AU - Cahn, Jean Yves
AU - Weisdorf, Daniel J.
N1 - Funding Information:
Supported primarily by Public Health Service Grant/Cooperative Agreement No. 5U24CA076518 from the National Cancer Institute, National Heart, Lung, and Blood Institute, and National Institute of Allergy and Infectious Diseases; Grant/Cooperative Agreement No. 1U24HL138660 from the National Heart, Lung, and Blood Institute and National Cancer Institute; Contract No. HHSH250201700006C from the Health Resources and Services Administration, Department of Health and Human Services; Grants No. N00014-17-1-2388, N00014-17-1-2850, and N00014-18-1-2045 from the Office of Naval Research; and funding from Adaptive Biotechnologies; *Amgen; anonymous donation to the Medical College of Wisconsin; Astellas Pharma US; Atara Biotherapeutics; Be the Match Foundation; *bluebird bio; *Bristol-Myers Squibb Oncology; *Celgene; *Chimerix; *CytoSen Therapeutics; Fred Hutchinson Cancer Research Center; Gamida Cell; Gilead Sciences; HistoGenetics; Immucor; *Incyte; Janssen Scientific Affairs; *Jazz Pharmaceuticals; Karius; Karyopharm Therapeutics; *Kite Pharma; Medac; *Mediware; Medical College of Wisconsin; *Merck; *Mesoblast; MesoScale Diagnostics; Millennium Pharmaceuticals, Takeda Oncology; *Miltenyi Biotec; Mundipharma EDO; National Marrow Donor Program; Novartis Pharmaceuticals; Patient-Centered Outcomes Research Institute; *Pfizer; *Pharmacyclics; Predicted Indirectly ReCognizable HLA Epitopes; *Sanofi Genzyme; *Seattle Genetics; Shire; Spectrum Pharmaceuticals; St. Baldrick’s Foundation; Swedish Orphan Biovitrum; *Takeda Oncology; and University of Minnesota, all for the Center for International Blood and Marrow Transplant Research; [*corporate members].
Funding Information:
Supported primarily by Public Health Service Grant/Cooperative Agreement No. 5U24CA076518 from the National Cancer Institute, National Heart, Lung, and Blood Institute, and National Institute of Allergy and Infectious Diseases; Grant/Cooperative Agreement No. 1U24HL138660 from the National Heart, Lung, and Blood Institute and National Cancer Institute; Contract No. HHSH250201700006C from the Health Resources and Services Administration, Department of Health and Human Services; Grants No. N00014-17-1-2388, N00014-17-1-2850, and N00014-18-1-2045 from the Office of Naval Research; and funding from Adaptive Biotechnologies; *Amgen; anonymous donation to the Medical College of Wisconsin; Astellas Pharma US; Atara Biotherapeutics; Be the Match Foundation; *bluebird bio; *Bristol-Myers Squibb Oncology; *Celgene; *Chimerix; *CytoSen Therapeutics; Fred Hutchinson Cancer Research Center; Gamida Cell; Gilead Sciences; HistoGenetics; Immucor; *Incyte; Janssen Scientific Affairs; *Jazz
Publisher Copyright:
© 2020 by American Society of Clinical Oncology.
PY - 2020/5/4
Y1 - 2020/5/4
N2 - PURPOSE There is no consensus on the best choice of an alternative donor (umbilical cord blood [UCB], haploidentical, one-antigen mismatched [7/8]–bone marrow [BM], or 7/8-peripheral blood [PB]) for hematopoietic cell transplantation (HCT) for patients lacking an HLA-matched related or unrelated donor. METHODS We report composite end points of graft-versus-host disease (GVHD)–free relapse-free survival (GRFS) and chronic GVHD (cGVHD)–free relapse-free survival (CRFS) in 2,198 patients who underwent UCB (n 5 838), haploidentical (n 5 159), 7/8-BM (n 5 241), or 7/8-PB (n 5 960) HCT. All groups were divided by myeloablative conditioning (MAC) intensity or reduced intensity conditioning (RIC), except haploidentical group in which most received RIC. To account for multiple testing, P, .0071 in multivariable analysis and P, .00025 in direct pairwise comparisons were considered statistically significant. RESULTS In multivariable analysis, haploidentical group had the best GRFS, CRFS, and overall survival (OS). In the direct pairwise comparison of other groups, among those who received MAC, there was no difference in GRFS or CRFS among UCB, 7/8-BM, and 7/8-PB with serotherapy (alemtuzumab or antithymocyte globulin) groups. In contrast, the 7/8-PB without serotherapy group had significantly inferior GRFS, higher cGVHD, and a trend toward worse CRFS (hazard ratio [HR], 1.38; 95% CI, 1.13 to 1.69; P 5 .002) than the 7/8-BM group and higher cGVHD and trend toward inferior CRFS (HR, 1.36; 95% CI, 1.14 to 1.63; P 5 .0006) than the UCB group. Among patients with RIC, all groups had significantly inferior GRFS and CRFS compared with the haploidentical group. CONCLUSION Recognizing the limitations of a registry retrospective analysis and the possibility of center selection bias in choosing donors, our data support the use of UCB, 7/8-BM, or 7/8-PB (with serotherapy) grafts for patients undergoing MAC HCT and haploidentical grafts for patients undergoing RIC HCT. The haploidentical group had the best GRFS, CRFS, and OS of all groups.
AB - PURPOSE There is no consensus on the best choice of an alternative donor (umbilical cord blood [UCB], haploidentical, one-antigen mismatched [7/8]–bone marrow [BM], or 7/8-peripheral blood [PB]) for hematopoietic cell transplantation (HCT) for patients lacking an HLA-matched related or unrelated donor. METHODS We report composite end points of graft-versus-host disease (GVHD)–free relapse-free survival (GRFS) and chronic GVHD (cGVHD)–free relapse-free survival (CRFS) in 2,198 patients who underwent UCB (n 5 838), haploidentical (n 5 159), 7/8-BM (n 5 241), or 7/8-PB (n 5 960) HCT. All groups were divided by myeloablative conditioning (MAC) intensity or reduced intensity conditioning (RIC), except haploidentical group in which most received RIC. To account for multiple testing, P, .0071 in multivariable analysis and P, .00025 in direct pairwise comparisons were considered statistically significant. RESULTS In multivariable analysis, haploidentical group had the best GRFS, CRFS, and overall survival (OS). In the direct pairwise comparison of other groups, among those who received MAC, there was no difference in GRFS or CRFS among UCB, 7/8-BM, and 7/8-PB with serotherapy (alemtuzumab or antithymocyte globulin) groups. In contrast, the 7/8-PB without serotherapy group had significantly inferior GRFS, higher cGVHD, and a trend toward worse CRFS (hazard ratio [HR], 1.38; 95% CI, 1.13 to 1.69; P 5 .002) than the 7/8-BM group and higher cGVHD and trend toward inferior CRFS (HR, 1.36; 95% CI, 1.14 to 1.63; P 5 .0006) than the UCB group. Among patients with RIC, all groups had significantly inferior GRFS and CRFS compared with the haploidentical group. CONCLUSION Recognizing the limitations of a registry retrospective analysis and the possibility of center selection bias in choosing donors, our data support the use of UCB, 7/8-BM, or 7/8-PB (with serotherapy) grafts for patients undergoing MAC HCT and haploidentical grafts for patients undergoing RIC HCT. The haploidentical group had the best GRFS, CRFS, and OS of all groups.
UR - http://www.scopus.com/inward/record.url?scp=85086748427&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85086748427&partnerID=8YFLogxK
U2 - 10.1200/JCO.19.00396
DO - 10.1200/JCO.19.00396
M3 - Article
C2 - 32364845
AN - SCOPUS:85086748427
SN - 0732-183X
VL - 38
SP - 2062
EP - 2076
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 18
ER -