Journal Article

Unmanipulated haploidentical bone marrow transplantation and post-transplant cyclophosphamide for hematologic malignanices following a myeloablative conditioning: an update

Colombo, N, Bacigalupo, A, Van Lint, M T, Grasso, R, Gualandi, F, Bregante, S, Luchetti, S, Di Grazia, C, Dominietto, A, Ghiso, A, Raiola, A M, Lamparelli, T, Geroldi, S, Pozzi, S, Varaldo, R, Tedone, E

2015

Overview

This is a report of 148 patients with hematologic malignancies who received an unmanipulated haploidentical bone marrow transplant (BMT), followed by post-transplant high-dose cyclophosphamide (PT-CY). All patients received a myeloablative conditioning consisting of thiotepa, busulfan, fludarabine ( n =92) or TBI, fludarabine ( n =56). The median age was 47 years (17–74); 47 patients were in first remission (CR1), 37 in second remission (CR2) and 64 had an active disease; all patients were first grafts. The diagnosis was acute leukemia ( n =75), myelodisplastic syndrome ( n =24), myelofibrosis ( n =16), high-grade lytmphoma ( n =15) and others ( n =18). GVHD prophylaxis consisted in PT-CY on days +3 and +5, cyclosporine (from day 0), and mycophenolate (from day +1). The median day for neutrophil engraftment was day +18 (13–32). The cumulative incidence of grades II–IV acute GVHD was 24%, and of grades III–IV GVHD 10%. The incidence of moderate–severe chronic GVHD was 12%. With a median follow-up for the surviving patients of 313 days (100–1162), the cumulative incidence of transplant-related mortality (TRM) is 13%, and the relapse-related death is 23%. The actuarial 22 months overall survival is 77% for CR1 patients, 49% for CR2 patients and 38% for patients grafted in relapse ( P <0.001). Major causes of death were relapse (22%), GVHD (2%) and infections (6%). We confirm our initial results, suggesting that a myeloablative conditioning regimen followed by unmanipulated haploidentical BMT with PT-CY, results in a low risk of acute and chronic GVHD and encouraging rates of TRM and overall survival, also for patients with active disease at the time of transplant.

• Publisher: Nature Publishing Group UK,Nature Publishing Group
• Subject: 631/250/1904 / 692/699/1541/1990 / 692/700/565/1436 / Adolescent / Adult / Aged / Allografts / Blood cancer / Body weight / Bone marrow / Bone Marrow Transplantation / Busulfan / Care and treatment / Cell Biology / Conditioning / Cyclophosphamide / Cyclophosphamide - administration & dosage / Cyclosporins / Diagnosis / Disease prevention / Disease-Free Survival / Female / Fludarabine / Follow-Up Studies / Graft Survival - drug effects / Graft vs Host Disease - mortality / Graft vs Host Disease - prevention & control / Graft-versus-host reaction / Health aspects / Hematologic Neoplasms - mortality / Hematologic Neoplasms - therapy / Hematology / Humans / Internal Medicine / Leukemia / Leukocytes (neutrophilic) / Male / Measurement / Medicine / Medicine & Public Health / Middle Aged / Mycophenolic acid / Myelofibrosis / original-article / Public Health / Remission / Remission (Medicine) / Stem cell transplantation / Stem Cells / Survival / Survival Rate / Transplantation / Transplantation Conditioning / Transplants & implants