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HLA-matching with PTCy: a reanalysis of a CIBMTR dataset with propensity score matching and donor age

Blood or marrow transplantation (BMT) outcomes using haploidentical donors (Haplo) and posttransplant cyclophosphamide (PTCy)-based graft-versus-host disease (GVHD) prophylaxis compare favorably to HLA-matched donors using calcineurin inhibitor–based prophylaxis. A recent Center for International Bl...

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Autores principales: Ambinder, Alexander, Jain, Tania, Tsai, Hua-Ling, Horowitz, Mary M., Jones, Richard J., Varadhan, Ravi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Society of Hematology 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9327541/
https://www.ncbi.nlm.nih.gov/pubmed/35613462
http://dx.doi.org/10.1182/bloodadvances.2022007741
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author Ambinder, Alexander
Jain, Tania
Tsai, Hua-Ling
Horowitz, Mary M.
Jones, Richard J.
Varadhan, Ravi
author_facet Ambinder, Alexander
Jain, Tania
Tsai, Hua-Ling
Horowitz, Mary M.
Jones, Richard J.
Varadhan, Ravi
author_sort Ambinder, Alexander
collection PubMed
description Blood or marrow transplantation (BMT) outcomes using haploidentical donors (Haplo) and posttransplant cyclophosphamide (PTCy)-based graft-versus-host disease (GVHD) prophylaxis compare favorably to HLA-matched donors using calcineurin inhibitor–based prophylaxis. A recent Center for International Blood and Marrow Transplant Research analysis of patients receiving homogenous PTCy-based prophylaxis found that, with reduced intensity conditioning, Haplo BMTs had worse outcomes than matched unrelated donor (MUD) BMTs. Due to significant differences between groups, we reanalyzed the dataset using propensity score matching and, additionally, added a donor age variable. After matching MUD BMTs to Haplo BMTs in a 1:5 ratio, no significant differences were found between groups across all measured baseline characteristics. Outcomes analyses demonstrated no significant differences in overall survival (hazard ratio [HR] of mortality with MUD vs Haplo [95% confidence interval], 0.95 [0.65-1.16], P = .75), disease-free survival (HR of relapse or death, 0.98 [0.73-1.18], P = .89), relapse rate (HR, 1.06 [0.77-1.38], P = .69), or nonrelapse mortality (NRM) (HR, 0.85 [0.42-1.13], P = .49) between groups. After stratification by conditioning intensity, MUD BMTs in the reduced-intensity cohort had lower risk of NRM (HR, 0.56 [0.14-0.99], P = .05), with no significant difference in other clinical outcomes. These results suggest the effect of HLA matching on BMT outcomes with PTCy is less meaningful than previously reported. Timely identification of a young, at least half-matched (related or unrelated) donor may be more important than finding a fully matched donor if the latter leads to a delay in BMT or use of an older donor.
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spelling pubmed-93275412022-08-01 HLA-matching with PTCy: a reanalysis of a CIBMTR dataset with propensity score matching and donor age Ambinder, Alexander Jain, Tania Tsai, Hua-Ling Horowitz, Mary M. Jones, Richard J. Varadhan, Ravi Blood Adv Transplantation Blood or marrow transplantation (BMT) outcomes using haploidentical donors (Haplo) and posttransplant cyclophosphamide (PTCy)-based graft-versus-host disease (GVHD) prophylaxis compare favorably to HLA-matched donors using calcineurin inhibitor–based prophylaxis. A recent Center for International Blood and Marrow Transplant Research analysis of patients receiving homogenous PTCy-based prophylaxis found that, with reduced intensity conditioning, Haplo BMTs had worse outcomes than matched unrelated donor (MUD) BMTs. Due to significant differences between groups, we reanalyzed the dataset using propensity score matching and, additionally, added a donor age variable. After matching MUD BMTs to Haplo BMTs in a 1:5 ratio, no significant differences were found between groups across all measured baseline characteristics. Outcomes analyses demonstrated no significant differences in overall survival (hazard ratio [HR] of mortality with MUD vs Haplo [95% confidence interval], 0.95 [0.65-1.16], P = .75), disease-free survival (HR of relapse or death, 0.98 [0.73-1.18], P = .89), relapse rate (HR, 1.06 [0.77-1.38], P = .69), or nonrelapse mortality (NRM) (HR, 0.85 [0.42-1.13], P = .49) between groups. After stratification by conditioning intensity, MUD BMTs in the reduced-intensity cohort had lower risk of NRM (HR, 0.56 [0.14-0.99], P = .05), with no significant difference in other clinical outcomes. These results suggest the effect of HLA matching on BMT outcomes with PTCy is less meaningful than previously reported. Timely identification of a young, at least half-matched (related or unrelated) donor may be more important than finding a fully matched donor if the latter leads to a delay in BMT or use of an older donor. American Society of Hematology 2022-07-25 /pmc/articles/PMC9327541/ /pubmed/35613462 http://dx.doi.org/10.1182/bloodadvances.2022007741 Text en © 2022 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.
spellingShingle Transplantation
Ambinder, Alexander
Jain, Tania
Tsai, Hua-Ling
Horowitz, Mary M.
Jones, Richard J.
Varadhan, Ravi
HLA-matching with PTCy: a reanalysis of a CIBMTR dataset with propensity score matching and donor age
title HLA-matching with PTCy: a reanalysis of a CIBMTR dataset with propensity score matching and donor age
title_full HLA-matching with PTCy: a reanalysis of a CIBMTR dataset with propensity score matching and donor age
title_fullStr HLA-matching with PTCy: a reanalysis of a CIBMTR dataset with propensity score matching and donor age
title_full_unstemmed HLA-matching with PTCy: a reanalysis of a CIBMTR dataset with propensity score matching and donor age
title_short HLA-matching with PTCy: a reanalysis of a CIBMTR dataset with propensity score matching and donor age
title_sort hla-matching with ptcy: a reanalysis of a cibmtr dataset with propensity score matching and donor age
topic Transplantation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9327541/
https://www.ncbi.nlm.nih.gov/pubmed/35613462
http://dx.doi.org/10.1182/bloodadvances.2022007741
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