Author:
Lacan Claire,Lambert Jérôme,Forcade Edouard,Robin Marie,Chevallier Patrice,Loron Sandrine,Bulabois Claude-Éric,Orvain Corentin,Ceballos Patrice,Daguindau Etienne,Charbonnier Amandine,Chalandon Yves,Bernard Marc,Simand Célestine,Rubio Marie-Thérèse,Turlure Pascal,Maertens Johan,Huynh Anne,Loschi Michael,Bay Jacques-Olivier,Guillerm Gaëlle,Alani Mustafa,Castilla-Llorente Cristina,Poiré Xavier,Chantepie Sylvain,Maillard Natacha,Beguin Yves,Marçais Ambroise,Cornillon Jérôme,Malfuson Jean-Valère,Maury Sébastien,Meuleman Nathalie,Villate Alban,Bekadja Mohammed-Amine,Walter-Petrich Anouk,Jacque Nathalie,Srour Micha,Devillier Raynier,Nguyen Stéphanie
Abstract
AbstractThe use of peripheral blood (PB) or bone marrow (BM) stem cells graft in haploidentical hematopoietic stem cell transplantation with post-transplant cyclophosphamide (PTCy) for graft-versus-host disease (GVHD) prophylaxis remains controversial. Moreover, the value of adding anti-thymoglobulin (ATG) to PTCy is unknown. A total of 1344 adult patients received an unmanipulated haploidentical transplant at 37 centers from 2012 to 2019 for hematologic malignancy. We compared the outcomes of patients according to the type of graft, using a propensity score analysis. In total population, grade II–IV and III–IV acute GVHD (aGVHD) were lower with BM than with PB. Grade III–IV aGVHD was lower with BM than with PB + ATG. All outcomes were similar in PB and PB + ATG groups. Then, in total population, adding ATG does not benefit the procedure. In acute leukemia, myelodysplastic syndrome and myeloproliferative syndrome (AL-MDS-MPS) subgroup receiving non-myeloablative conditioning, risk of relapse was twice greater with BM than with PB (51 vs. 22%, respectively). Conversely, risk of aGVHD was greater with PB (38% for aGVHD II–IV; 16% for aGVHD III–IV) than with BM (28% for aGVHD II–IV; 8% for aGVHD III–IV). In this subgroup with intensified conditioning regimen, risk of relapse became similar with PB and BM but risk of aGVHD III–IV remained higher with PB than with BM graft (HR = 2.0; range [1.17–3.43], p = 0.012).
Publisher
Springer Science and Business Media LLC
Subject
Cancer Research,Oncology,Molecular Biology,Hematology