Alternative donor transplantation for myelodysplastic syndromes: Haploidentical relative and matched unrelated donors

Michael R. Grunwald, Mei Jie Zhang, Hany Elmariah, Mariam H. Johnson, Andrew St Martin, Asad Bashey, Minoo Battiwalla, Christopher N. Bredeson, Edward Copelan, Corey S. Cutler, Biju R. George, Vikas Gupta, Christopher Kanakry, Rohtesh S. Mehta, Filippo Milano, Alberto Mussetti, Ryotaro Nakamura, Taiga Nishihori, Wael Saber, Melhem SolhDaniel J. Weisdorf, Mary Eapen

Research output: Contribution to journalArticlepeer-review

Abstract

We compared outcomes in 603 patients with myelodysplastic syndrome (MDS) after HLAhaploidentical relative (n5 176) and HLA-matched unrelated (n 5427) donor hematopoietic cell transplantation (HCT) from 2012 to 2017, using the Center for International Blood and Marrow Transplant Research database. All transplantations used reduced-intensity conditioning regimens. Total-body irradiation plus cyclophosphamide and fludarabine was the predominant regimen for HLA-haploidentical relative donor HCT, and graft-versus-host disease (GVHD) prophylaxis was uniformly posttransplantation cyclophosphamide, calcineurin inhibitor, and mycophenolate. Fludarabine with busulfan or melphalan was the predominant regimen for HLA-matched unrelated donor HCT, and GVHD prophylaxis was calcineurin inhibitor with mycophenolate or methotrexate. Results of multivariate analysis revealed higher relapse (hazard ratio [HR], 1.56; P 5 .0055; 2-year relapse rate, 48% vs 33%) and lower disease-free survival (DFS) rates after HLA-haploidentical relative donor HCT (HR, 1.29; P 5 .042; 2-year DFS, 29% vs 36%). However, overall survival (OS) rates did not differ between donor type (HR, 0.94; P 5 .65; 2-year OS, 46% for HLA-haploidentical and 44% for HLA-matched unrelated donor HCT) because of mortality associated with chronic GVHD. Acute grade 2 to 4 GVHD (HR, 0.44; P , .0001) and chronic GVHD (HR, 0.36; P , .0001) were lower after HLA-haploidentical relative donor HCT. By 2 years, probability of death resulting from chronic GVHD was lower after HLA-haploidentical relative compared with HLAmatched unrelated donor HCT (6% vs 21%), negating any potential survival advantage from better relapse control. Both donor types extend access to transplantation for patients with MDS; strategies for better relapse control are desirable for HLAhaploidentical relative donor HCT, and effective GVHD prophylaxis regimens are needed for unrelated donor HCT.

Original languageEnglish (US)
Pages (from-to)975-983
Number of pages9
JournalBlood Advances
Volume5
Issue number4
DOIs
StatePublished - Feb 23 2021

Bibliographical note

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© 2021 American Society of Hematology. All rights reserved.

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