期刊
BLOOD ADVANCES
卷 6, 期 14, 页码 4335-4346出版社
ELSEVIER
DOI: 10.1182/bloodadvances.2022007741
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资金
- National Institutes of Health (NIH) National Cancer Institute (NCI) [P01 CA225618, P30 CA006973]
- Public Health Service from National Cancer Institute (NCI) [U24CA076518]
- National Heart, Lung, and Blood Institute (NHLBI)
- National Institute of Allergy and Infectious Diseases (NIAID)
- Health Resources and Services Administration (HRSA) [HHSH250201700006C]
- Office of Naval Research [N00014-20-1-2832, N00014-21-1-2954]
- Be the Match Foundation
- Medical College of Wisconsin
- National Marrow Donor Program
- AbbVie
- Actinium Pharmaceuticals, Inc.
- Adaptive Biotechnologies Corporation
- Adienne SA
- Allogene
- Allovir, Inc.
- Amgen, Inc.
- Anthem
- Astellas Pharma US
- Atara Biotherapeutics
- bluebird bio, inc.
- Bristol Myers Squibb Co.
- CareDx Inc.
- CRISPR
- CSL Behring
- CytoSen Therapeutics, Inc.
- Daiichi Sankyo Co., Ltd.
- Eurofins Viracor
- DBA Eurofins Transplant Diagnostics
- Fate Therapeutics
- Gamida-Cell, Ltd.
- Gilead
- GlaxoSmithKline
- HistoGenetics
- Incyte Corporation
- Iovance
- Janssen Research & Development, LLC
- Janssen/Johnson Johnson
- Jasper Therapeutics
- Jazz Pharmaceuticals, Inc.
- Kadmon
- Karius
- Kiadis Pharma
- Kite, a Gilead Company
- Kyowa Kirin
- Legend Biotech
- Magenta Therapeutics
- Mallinckrodt Pharmaceuticals
- Medac GmbH
- Medexus
- Merck Co.
- Millennium
- Takeda Oncology Co.
- Miltenyi Biotec, Inc.
- MorphoSys
- Novartis Pharmaceuticals Corporation
- Omeros Corporation
- OptumHealth
- Orca Biosystems, Inc.
- Ossium Health, Inc
- Pfizer, Inc.
- Pharmacyclics, LLC
- Priothera
- Sanofi Genzyme
- Stemcyte
- Takeda Pharmaceuticals
- Talaris Therapeutics
- Terumo Blood and Cell Technologies
- TG Therapeutics
- Tscan
- Vertex
- Xenikos BV
This study compares the outcomes of blood or marrow transplantation using haploidentical donors and HLA-matched donors with different prophylactic methods. The results suggest that there is no significant difference in overall survival, disease-free survival, relapse rate, and nonrelapse mortality between the two groups. The impact of HLA matching on transplant outcomes with posttransplant cyclophosphamide may be less meaningful than previously reported.
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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