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Article Dans Une Revue Blood Advances Année : 2018

Related donor transplants: has posttransplantation cyclophosphamide nullified the detrimental effect of HLA mismatch?

M Robinson Tara
  • Fonction : Auteur
J Fuchs Ephraim
  • Fonction : Auteur
Mei-Jie Zhang
  • Fonction : Auteur
Andrew St Martin
  • Fonction : Auteur
Myriam Labopin
  • Fonction : Auteur
A Keesler Daniel
  • Fonction : Auteur
Didier Blaise
Asad Bashey
  • Fonction : Auteur
Jean-Henri Bourhis
  • Fonction : Auteur
Fabio Ciceri
  • Fonction : Auteur
O Ciurea Stefan
  • Fonction : Auteur
M Devine Steven
  • Fonction : Auteur
Mohamad Mohty
  • Fonction : Auteur
R Mccurdy Shannon
  • Fonction : Auteur
Noel Milpied
  • Fonction : Auteur
K Mcniece Ian
  • Fonction : Auteur
Vanderson Rocha
  • Fonction : Auteur
Rizwan Romee
  • Fonction : Auteur
Gerard Socie
  • Fonction : Auteur
J Soiffer Robert
  • Fonction : Auteur
Mary Eapen
  • Fonction : Auteur
Arnon Nagler
  • Fonction : Auteur

Résumé

We sought to identify whether posttransplantation cyclophosphamide (PT-Cy) reduces or eliminates the detrimental impact of HLA mismatching on outcomes of HLA-haploidentical related donor transplantation for acute leukemia. Data from 2143 donor-recipient pairs (n = 218 haploidentical sibling; n = 218 offspring; n = 1707 HLA-matched sibling) with acute myeloid or lymphoblastic leukemia were studied. All received a calcineurin inhibitor for graft-versus-host disease (GVHD) prophylaxis while high-dose PT-Cy was also given to recipients of haploidentical transplant. Patient age correlated with donor-recipient relationship: haploidentical siblings donated to patients aged 18 to 54 years whereas offspring donated to patients aged 55 to 76 years. Therefore, transplant outcomes were examined separately in the 2 patient age groups. In patients aged 18 to 54 years, there were no significant differences in outcomes except chronic GVHD, which was lower after haploidentical sibling compared to HLA-matched sibling transplant (hazard ratio [HR], 0.63; P < .001). In patients aged 55 to 76 years, despite lower chronic GVHD (HR, 0.42; P < .001), graft failure (14% vs 6%; P = .003), nonrelapse mortality (HR, 1.48; P = .02), and overall mortality (HR, 1.32; P = .003) were higher after transplant from offspring compared with an HLA-matched sibling. These data demonstrate a superior outcome in older recipients when using an HLA-matched sibling instead of offspring, although there were differences in transplant platforms (GVHD prophylaxis and graft type) between the 2 groups. Validation of these findings requires a prospective randomized trial wherein the transplant platforms can be closely matched.

Dates et versions

hal-04411325 , version 1 (23-01-2024)

Identifiants

Citer

M Robinson Tara, J Fuchs Ephraim, Mei-Jie Zhang, Andrew St Martin, Myriam Labopin, et al.. Related donor transplants: has posttransplantation cyclophosphamide nullified the detrimental effect of HLA mismatch?. Blood Advances, 2018, Blood Advances, 2, pp.1180-1186. ⟨10.1182/bloodadvances.2018018291⟩. ⟨hal-04411325⟩

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