Composite GRFS and CRFS Outcomes after Adult Alternative Donor HCT

Rohtesh S. Mehta, Shernan G. Holtan, Tao Wang, Michael T. Hemmer, Stephen R. Spellman, Mukta Arora, Daniel R. Couriel, Amin M. Alousi, Joseph Pidala, Hisham Abdel Azim, Vaibhav Agrawal, Ibrahim Ahmed, A. Samer Al-Homsi, Mahmoud Aljurf, Joseph H. Antin, Medhat Askar, Jeffery J. Auletta, Vijaya Raj Bhatt, Lynette Chee, Saurabh ChhabraAndrew Daly, Zachariah DeFilipp, James Gajewski, Robert Peter Gale, Usama Gergis, Peiman Hematti, Gerhard C. Hildebrandt, William J. Hogan, Yoshihiro Inamoto, Rodrigo Martino, Navneet S. Majhail, David I. Marks, Taiga Nishihori, Richard F. Olsson, Attaphol Pawarode, Miguel Angel Diaz, Tim Prestidge, Hemalatha G. Rangarajan, Olle Ringden, Ayman Saad, Bipin N. Savani, Hélène Schoemans, Sachiko Seo, Kirk R. Schultz, Melhem Solh, Thomas Spitzer, Jan Storek, Takanori Teshima, Leo F. Verdonck, Baldeep Wirk, Jean A. Yared, Jean Yves Cahn, Daniel J. Weisdorf

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2062-2076
Number of pages15
JournalJournal of Clinical Oncology
Volume38
Issue number18
DOIs
StatePublished - May 4 2020

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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    Mehta, R. S., Holtan, S. G., Wang, T., Hemmer, M. T., Spellman, S. R., Arora, M., Couriel, D. R., Alousi, A. M., Pidala, J., Abdel Azim, H., Agrawal, V., Ahmed, I., Al-Homsi, A. S., Aljurf, M., Antin, J. H., Askar, M., Auletta, J. J., Bhatt, V. R., Chee, L., ... Weisdorf, D. J. (2020). Composite GRFS and CRFS Outcomes after Adult Alternative Donor HCT. Journal of Clinical Oncology, 38(18), 2062-2076. https://doi.org/10.1200/JCO.19.00396