Long-term outcomes after haploidentical stem cell transplantation (haplo-SCT) for hematologic malignancies Supawee Saengboon, Jeremy Ramdial, Neeraj Saini, Amanda Olson, Jin Im, Chitra Hosing, Uday Popat, Elizabeth Shpall, Richard E. Champlin and Samer A. Srour Department of Stem Cell Transplantation and Cellular Therapy The University of Texas MD Anderson Cancer Center, Houston, Texas
Table 1 Baseline characteristics
Abstract (Click on the text to edit) Background
Variable
All Patients
2-year landmark
(N=366)
(N=144)
Age years
• Allogeneic SCT is curative for large proportion of patients with high-risk hematologic malignancies • The introduction of posttransplant cyclophosphamide (PTCy)-based GVHD prophylaxis led to significant improvements in haplo-SCT outcomes and a remarkable increase in its use in the past decade • We aimed from this study to assess long-term outcomes of patients who underwent haplo-SCT
Median (range)
48 (18-72)
45 (18-72)
Age at transplant
<55 years
206 (61.31%)
97 (67.36%)
≥55 years
130 (38.69%)
47 (32.64%)
Gender
Male
196 (58.33%)
84 (58.33%)
Female
140 (41.67%)
60 (41.67%)
Figure 1
Figure 2
Disease Subtype
AML/MDS
196 (58.33%)
80 (55.56%)
ALL
55 (16.37%)
22 (15.28%)
MPN
37 (11.01%)
22 (15.28%)
Lymphoid malignancies
48 (14.29%)
20 (13.89%)
Methods
KPS at transplant
Figure 3
KPS 90-100
207 (68.32%)
93 (69.92%)
Results Continued
KPS<90
96 (31.68%)
40 (30.08%)
• All consecutive adult patients who had their first haplo- SCT between 2/2009 and 3/2019 • Long-term survivors defined as patients who were alive and disease free at 2 years after transplant ✓ Primary end points: PFS and OS ✓ Secondary endpoints: cumulative incidence of relapse (CIR) and non-relapse mortality (NRM) Results • Table 1 summarizes baseline characteristics of all patients and the long-term survivors • The 4-year PFS and OS for all study patients were 42% and 47% • With a median follow-up of 52 months for the long- term survival group, the 4-year PFS and OS were 92% and 96%, respectively (Figure 1&2)
DRI
Low/Intermediate DRI
189 (58.88%)
100 (72.46%)
High/Very High DRI
132 (41.12%)
38 (27.54%)
• In MVA, age ≥ 55 was the only predictive for inferior PFS (HR 2.63, 95% CI: 1.01-6.84; p=0.047) and OS (HR 3.33, 95% CI: 1.08-12.23; p=0.036)
HCT-CI
HCT- CI ≤ 3
218 (64.88%)
101 (70.14%)
HCT-CI>3
118 (35.12%)
43 (29.86%)
Stem cell source
Peripheral blood
54 (16.07%)
18 (12.50%)
• Figure 3 shows NRM and CIR rates
Bone marrow
282 (83.93%)
126 (87.50%)
Conditioning regimen
• Thirteen patients (9%) died in the long-term survivor group: ✓ Two died of relapse ✓ Secondary primary malignancy was the most frequent cause of NRM (n=4) ✓ Two patients died from infection ✓ One patient each from GVHD and sudden death ✓ For 3 patients, the cause of death was unknown
Reduced intensity
298 (88.69%)
127 (88.19)
Conclusion
Myeloablative
38 (11.31%)
17 (11.81%)
Patient-Donor CMV
R-R
186 (64.14%)
79 (66.39%)
• Our findings suggest an excellent long-term survival for patients who were disease-free at 2 years after haplo-SCT • Late relapses were low • Age was the only predictive factor for survival
R-NR
104 (35.86%)
40 (33.61%)
Acute GVHD Gr2-4 at 2 years
No
192 (57.14%)
90 (62.50%)
Yes
144 (42.86%)
54 (37.50%)
Chronic GVHD at 2 years
No
291 (86.61%)
116 (80.56%)
Yes
45 (13.39%)
28 (19.44%)
The University of Texas MD Anderson Cancer Center
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