[HTML][HTML] Comparable composite endpoints after HLA-matched and HLA-haploidentical transplantation with post-transplantation cyclophosphamide

SR McCurdy, YL Kasamon, CG Kanakry… - …, 2017 - ncbi.nlm.nih.gov
SR McCurdy, YL Kasamon, CG Kanakry, J Bolaños-Meade, HL Tsai, MM Showel…
Haematologica, 2017ncbi.nlm.nih.gov
Composite endpoints that not only encompass mortality and relapse, but other critical post-
transplant events such as graft-versus-host disease, are being increasingly utilized to
quantify survival without significant morbidity after allogeneic blood or marrow
transplantation. High-dose, post-transplantation cyclophosphamide reduces severe graft-
versus-host disease with allogeneic marrow transplantation, making composite endpoints
after this management particularly interesting. We retrospectively analyzed 684 adults with …
Abstract
Composite endpoints that not only encompass mortality and relapse, but other critical post-transplant events such as graft-versus-host disease, are being increasingly utilized to quantify survival without significant morbidity after allogeneic blood or marrow transplantation. High-dose, post-transplantation cyclophosphamide reduces severe graft-versus-host disease with allogeneic marrow transplantation, making composite endpoints after this management particularly interesting. We retrospectively analyzed 684 adults with hematologic malignancies who received T-cell-replete bone marrow grafts and cyclophosphamide after myeloablative HLA-matched related (n= 192) or unrelated (n= 120), or non-myeloablative HLA-haploidentical (n= 372) donor transplantation. The median follow up was 4 (range, 0.02–11.4) years. Graft-versus-host disease-free, relapse-free survival was defined as the time after transplantation without grade III–IV acute graft-versus-host disease, chronic graft-versus-host disease requiring systemic treatment, relapse, or death. Chronic graft-versus-host disease-free, relapse-free survival was defined as the time after transplantation without moderate or severe chronic graft-versus-host disease, relapse, or death. One-year graft-versus-host disease-free, relapse-free survival and chronic graft-versus-host disease-free, relapse-free survival estimates were, respectively, 47%(95% CI: 41–55%) and 53%(95% CI: 46–61%) after myeloablative HLA-matched related, 42%(95% CI: 34–52%) and 52%(95% CI: 44–62%) after myeloablative HLA-matched unrelated, and 45%(95% CI: 40–50%) and 50%(95% CI: 45–55%) after non-myeloablative HLA-haploidentical donor transplantation. In multivariable models, there were no differences in graft-versus-host disease-free, or chronic graft-versus-host disease-free, relapse-free survival after either myeloablative HLA-matched unrelated or non-myeloablative HLA-haploidentical, compared with myeloablative HLA-matched related donor transplantation. Although limited by inclusion of dissimilar cohorts, we found that post-transplantation cyclophosphamide-based platforms yield comparable composite endpoints across conditioning intensity, donor type, and HLA match.
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