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Dreger, Peter; Sureda, Anna; Ahn, Kwang Woo; Eapen, Mary; Litovich, Carlos; Finel, Herve; Boumendil, Ariane; Gopal, Ajay; Herrera, Alex F.; Schmid, Christoph; Diez-Martin, Jose Luis; Fuchs, Ephraim; Bolanos-Meade, Javier; Gooptu, Mahasweta; Al Malki, Monzr M.; Castagna, Luca; Ciurea, Stefan O.; Dominietto, Alida; Blaise, Didier; Ciceri, Fabio; Tischer, Johanna; Corradini, Paolo; Montoto, Silvia; Robinson, Stephen; Gulbas, Zafer; Hamadani, Mehdi (2019): PTCy-based haploidentical vs matched related or unrelated donor reduced-intensity conditioning transplant for DLBCL. In: Blood Advances, Vol. 3, No. 3: pp. 360-369
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Abstract

This study retrospectively compared long-term outcomes of nonmyeloablative/reduced intensity conditioning (NMC/RIC) allogeneic hematopoietic cell transplantation (allo-HCT) from a haploidentical family donor (haplo-HCT) using posttransplant cyclophosphamide (PTCy) with those of matched sibling donor (MSD) and matched unrelated donor (MUD) with or without T-cell depletion (TCD+/TCD-) in patients with relapsed diffuse large B-cell lymphoma (DLBCL). Adult patients with DLBCL who had undergone their first NMC/RIC allo-HCT between 2008 and 2015 were included. Recipients of haplo-HCT were limited to those receiving graft-versus-host disease (GVHD) prophylaxis with PTCy. GVHD prophylaxis in MSD was limited to calcineurin inhibitor (CNI)-based approaches without in vivo TCD, while MUD recipients received CNI-based prophylaxis with or without TCD. Outcome analyses for overall survival (OS) and progression-free survival (PFS), nonrelapse mortality (NRM), and disease relapse/progression were calculated. A total of 1438 patients (haplo, 132;MSD, 525;MUD TCD+, 403;and MUD TCD-, 378) were included. Patients with haplo donors were significantly older, had a better performance status and had more frequently received total body irradiation-based conditioning regimens and bone marrow grafts than MSD and MUD TCD+ or TCD-. 3-year OS, PFS, NRM and relapse/progression incidence after haplo-HCT was 46%, 38%, 22%, and 41%, respectively, and not significantly different from outcomes of matched donor transplants on multivariate analyses. Haplo-HCT was associated with a lower cumulative incidence of chronic GVHD compared with MSD, MUD TCD+/TCD-. NMC/RIC haplo-HCT with PTCy seems to be a valuable alternative for patients with DLBCL considered for allo-HCT but lacking a matched donor.