Haploidentical transplants for patients with relapse after the first allograft

Samer A Srour; Piyanuch Kongtim; Gabriela Rondon; Julianne Chen; Demetrios Petropoulos; Jeremy Ramdial; Uday Popat; Partow Kebriaei; Muzaffar Qazilbash; Elizabeth J Shpall; Richard E Champlin; Stefan O Ciurea

doi:10.1002/ajh.25924

Haploidentical transplants for patients with relapse after the first allograft

Am J Hematol. 2020 Oct;95(10):1187-1192. doi: 10.1002/ajh.25924. Epub 2020 Aug 1.

Authors

Affiliations

¹ Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
² Center of Excellence in Applied Epidemiology and Hematopoietic Stem Cell Transplantation, Thammasat University, Pathumthani, Thailand.
³ Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
⁴ Current affiliation: Stefan O. Ciurea, MD, Professor, Hematopoietic Stem Cell Transplant and Cellular Therapy Program, Division of Hematology/Oncology, Chao Family Comprehensive Cancer Center, University of California Irvine, Orange, CA, USA.

PMID: 32619033
DOI: 10.1002/ajh.25924

Abstract

Relapse after allogeneic hematopoietic stem-cell transplantation (AHSCT) is associated with very poor outcomes. A second transplant offers the possibility of long-term disease control. We analyzed outcomes with haploidentical donors for second allograft at our institution. All consecutive patients with hematological malignancies (N = 29) who relapsed after AHSCT and underwent a haploidentical transplant (haploSCT) as second transplant between February 2009 and October 2018 were included. Median age was 36 years (interquartile range (IQR) 24-60); 83% of patients had high/very high disease risk index; 61% of AML/MDS patients had high-risk cytogenetics; and only 24% were in complete remission at transplant. With a median follow-up of 46.9 months, the 3-year relapse, non-relapse mortality (NRM), progression-free survival (PFS) and overall survival (OS) were 30%, 39%, 31% and 40%, respectively. In multivariable analysis (MVA), comorbidity index (HCT-CI) and detectable donor-specific anti-HLA antibodies (DSA) prior to second transplant were significantly associated with worse outcomes. Patients with HCT-CI <3 and without DSA had 3-year PFS and OS of 53% and 60.3%, respectively. Our findings suggest that haploSCT as second AHSCT is feasible and potentially curative. Lower HCT-CI and no DSA were associated with lower NRM and improved survival. Haploidentical grafts might be a preferred donor source for second AHSCT as these are high-risk patients who frequently need to proceed urgently to transplant.