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Bone Marrow versus Peripheral Blood Grafts for Haploidentical Hematopoietic Cell Transplantation with Post-Transplantation Cyclophosphamide
In the coronavirus disease 19 (COVID-19) pandemic era, the number of haploidentical hematopoietic cell transplantations (HCTs) with peripheral blood (PB) grafts increased significantly compared with HCTs with bone marrow (BM) grafts, which may be associated with adverse outcomes. We compared outcome...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8504778/ https://www.ncbi.nlm.nih.gov/pubmed/34537419 http://dx.doi.org/10.1016/j.jtct.2021.09.003 |
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author | Mehta, Rohtesh S. Saliba, Rima M. Alsfeld, Leonard C. Jorgensen, Jeffrey L. Wang, Sa A. Anderlini, Paolo Al-Atrash, Gheath Bashir, Qaiser Ciurea, Stefan O. Hosing, Chitra M. Im, Jin S. Kebriaei, Partow Khouri, Issa Marin, David Nieto, Yago Olson, Amanda Oran, Betul Popat, Uday R. Qazilbash, Muzaffar H. Ramdial, Jeremy Rondon, Gabriela Saini, Neeraj Srour, Samer A. Rezvani, Katayoun Shpall, Elizabeth J. Champlin, Richard E. Alousi, Amin M. |
author_facet | Mehta, Rohtesh S. Saliba, Rima M. Alsfeld, Leonard C. Jorgensen, Jeffrey L. Wang, Sa A. Anderlini, Paolo Al-Atrash, Gheath Bashir, Qaiser Ciurea, Stefan O. Hosing, Chitra M. Im, Jin S. Kebriaei, Partow Khouri, Issa Marin, David Nieto, Yago Olson, Amanda Oran, Betul Popat, Uday R. Qazilbash, Muzaffar H. Ramdial, Jeremy Rondon, Gabriela Saini, Neeraj Srour, Samer A. Rezvani, Katayoun Shpall, Elizabeth J. Champlin, Richard E. Alousi, Amin M. |
author_sort | Mehta, Rohtesh S. |
collection | PubMed |
description | In the coronavirus disease 19 (COVID-19) pandemic era, the number of haploidentical hematopoietic cell transplantations (HCTs) with peripheral blood (PB) grafts increased significantly compared with HCTs with bone marrow (BM) grafts, which may be associated with adverse outcomes. We compared outcomes of HCT in BM graft and PB graft recipients age ≥18 years with hematologic malignancies who underwent T cell- replete haploidentical HCT and received graft-versus-host disease (GVHD) prophylaxis with post-transplantation cyclophosphamide, tacrolimus, and mycophenolate mofetil. Among the 264 patients, 180 (68%) received a BM graft and 84 (32%) received a PB graft. The median patient age was 50 years in both groups. The majority (n = 199; 75%) received reduced-intensity conditioning. The rate of acute leukemia or myelodysplastic syndrome was higher in the BM graft recipients compared with the PB graft recipients (85% [n = 152] versus 55% [n = 46]; P < .01). The median times to neutrophil and platelet engraftment and the incidence of grade II-IV and grade III-IV acute GVHD (aGVHD) were comparable in the 2 groups. Among the patients with grade II-IV aGVHD, the rate of steroid-refractory aGVHD was 9% (95% confidence interval [CI], 5% to 18%) in the BM group versus 32% (95% CI, 19% to 54%) in the PB group (hazard ratio [HR], 3.7, 95% CI, 1.5 to 9.3; P = .006). At 1 year post-HCT, the rate of chronic GVHD (cGVHD) was 8% (95% CI, 4% to 13%) in the BM group versus 22% (95% CI, 14% to 36%) in the PB group (HR, 3.0; 95% CI, 1.4-6.6; P = .005), and the rate of systemic therapy-requiring cGVHD was 2.5% (95% CI, 1% to 7%) versus 14% (95% CI, 7% to 27%), respectively (HR, 5.6; 95% CI, 1.7 to 18; P = .004). The PB group had a significantly higher risk of bacterial and viral infections, with no appreciable advantage in the duration of hospitalization, immune reconstitution, relapse, nonrelapse mortality, or survival. Our data suggest a benefit of the use of BM grafts over PB grafts for haplo-HCT. |
format | Online Article Text |
id | pubmed-8504778 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-85047782021-10-12 Bone Marrow versus Peripheral Blood Grafts for Haploidentical Hematopoietic Cell Transplantation with Post-Transplantation Cyclophosphamide Mehta, Rohtesh S. Saliba, Rima M. Alsfeld, Leonard C. Jorgensen, Jeffrey L. Wang, Sa A. Anderlini, Paolo Al-Atrash, Gheath Bashir, Qaiser Ciurea, Stefan O. Hosing, Chitra M. Im, Jin S. Kebriaei, Partow Khouri, Issa Marin, David Nieto, Yago Olson, Amanda Oran, Betul Popat, Uday R. Qazilbash, Muzaffar H. Ramdial, Jeremy Rondon, Gabriela Saini, Neeraj Srour, Samer A. Rezvani, Katayoun Shpall, Elizabeth J. Champlin, Richard E. Alousi, Amin M. Transplant Cell Ther Full Length Article In the coronavirus disease 19 (COVID-19) pandemic era, the number of haploidentical hematopoietic cell transplantations (HCTs) with peripheral blood (PB) grafts increased significantly compared with HCTs with bone marrow (BM) grafts, which may be associated with adverse outcomes. We compared outcomes of HCT in BM graft and PB graft recipients age ≥18 years with hematologic malignancies who underwent T cell- replete haploidentical HCT and received graft-versus-host disease (GVHD) prophylaxis with post-transplantation cyclophosphamide, tacrolimus, and mycophenolate mofetil. Among the 264 patients, 180 (68%) received a BM graft and 84 (32%) received a PB graft. The median patient age was 50 years in both groups. The majority (n = 199; 75%) received reduced-intensity conditioning. The rate of acute leukemia or myelodysplastic syndrome was higher in the BM graft recipients compared with the PB graft recipients (85% [n = 152] versus 55% [n = 46]; P < .01). The median times to neutrophil and platelet engraftment and the incidence of grade II-IV and grade III-IV acute GVHD (aGVHD) were comparable in the 2 groups. Among the patients with grade II-IV aGVHD, the rate of steroid-refractory aGVHD was 9% (95% confidence interval [CI], 5% to 18%) in the BM group versus 32% (95% CI, 19% to 54%) in the PB group (hazard ratio [HR], 3.7, 95% CI, 1.5 to 9.3; P = .006). At 1 year post-HCT, the rate of chronic GVHD (cGVHD) was 8% (95% CI, 4% to 13%) in the BM group versus 22% (95% CI, 14% to 36%) in the PB group (HR, 3.0; 95% CI, 1.4-6.6; P = .005), and the rate of systemic therapy-requiring cGVHD was 2.5% (95% CI, 1% to 7%) versus 14% (95% CI, 7% to 27%), respectively (HR, 5.6; 95% CI, 1.7 to 18; P = .004). The PB group had a significantly higher risk of bacterial and viral infections, with no appreciable advantage in the duration of hospitalization, immune reconstitution, relapse, nonrelapse mortality, or survival. Our data suggest a benefit of the use of BM grafts over PB grafts for haplo-HCT. The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. 2021-12 2021-09-16 /pmc/articles/PMC8504778/ /pubmed/34537419 http://dx.doi.org/10.1016/j.jtct.2021.09.003 Text en © 2021 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. |
spellingShingle | Full Length Article Mehta, Rohtesh S. Saliba, Rima M. Alsfeld, Leonard C. Jorgensen, Jeffrey L. Wang, Sa A. Anderlini, Paolo Al-Atrash, Gheath Bashir, Qaiser Ciurea, Stefan O. Hosing, Chitra M. Im, Jin S. Kebriaei, Partow Khouri, Issa Marin, David Nieto, Yago Olson, Amanda Oran, Betul Popat, Uday R. Qazilbash, Muzaffar H. Ramdial, Jeremy Rondon, Gabriela Saini, Neeraj Srour, Samer A. Rezvani, Katayoun Shpall, Elizabeth J. Champlin, Richard E. Alousi, Amin M. Bone Marrow versus Peripheral Blood Grafts for Haploidentical Hematopoietic Cell Transplantation with Post-Transplantation Cyclophosphamide |
title | Bone Marrow versus Peripheral Blood Grafts for Haploidentical Hematopoietic Cell Transplantation with Post-Transplantation Cyclophosphamide |
title_full | Bone Marrow versus Peripheral Blood Grafts for Haploidentical Hematopoietic Cell Transplantation with Post-Transplantation Cyclophosphamide |
title_fullStr | Bone Marrow versus Peripheral Blood Grafts for Haploidentical Hematopoietic Cell Transplantation with Post-Transplantation Cyclophosphamide |
title_full_unstemmed | Bone Marrow versus Peripheral Blood Grafts for Haploidentical Hematopoietic Cell Transplantation with Post-Transplantation Cyclophosphamide |
title_short | Bone Marrow versus Peripheral Blood Grafts for Haploidentical Hematopoietic Cell Transplantation with Post-Transplantation Cyclophosphamide |
title_sort | bone marrow versus peripheral blood grafts for haploidentical hematopoietic cell transplantation with post-transplantation cyclophosphamide |
topic | Full Length Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8504778/ https://www.ncbi.nlm.nih.gov/pubmed/34537419 http://dx.doi.org/10.1016/j.jtct.2021.09.003 |
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