Graft-versus-host disease after an outpatient peripheral blood hematopoietic cell transplant using reduced-intensity conditioning: a single-center LATAM experience

ABSTRACT

Background

HLA compatibility predicts allogeneic hematopoietic cell transplant (allo-HCT) and graft-versus-host disease (GvHD) outcomes. There is insufficient information regarding GvHD outcomes for outpatient HLA-identical and haploidentical-HCT employing reduced-intensity conditioning (RIC).

Research design and methods

We compare GvHD outcomes between donor types and report risk factors associated with GvHD. Stem cell source was T-cell replete peripheral blood. GvHD prophylaxis was post-transplant cyclophosphamide (PT-CY), mycophenolic acid, and calcineurin inhibitors for haploidentical (n = 107) and oral cyclosporine (CsA) plus methotrexate i.v. for HLA-identical (n = 89) recipients.

Results

One hundred and ninety-six HCT transplant patients were included. aGvHD and cGvHD frequency were similar between HCT types. aGvHD severity was comparable, but severe cGvHD was less frequent in the haploidentical group (p = .011). One-hundred-day cumulative incidence (CI) of aGvHD for haploidentical and HLA-identical was 31% and 33% (p = .84); 2-year CI of cGvHD was 32% and 38% (p = .6), respectively. Haploidentical recipients had less steroid-refractory cGvHD (p = .043). Patients with cGvHD had less 2-year relapse (p = .003); both aGvHD and cGvHD conferred higher OS (p = .010 and p = .001), respectively. Male sex was protective for steroid-refractory cGvHD (p = .028).

Conclusions

Acute and chronic GvHD rates were comparable between HLA-identical and haploidentical transplant groups. cGvHD severity was lower in the haploidentical group.

KEYWORDS:

• HLA-identical transplant
• haploidentical transplant
• graft-versus-host disease
• outpatient transplant
• post-transplant cyclophosphamide
• reduced intensity conditioning

Declaration of interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants, or patents received or pending, or royalties.

Author contributions

JC Jaime-Pérez: Conception and study design, execution, analysis, and interpretation of the findings, wrote the article, and agreed on the journal to which the article was submitted. JD Meléndez-Flores: Execution, acquisition of data, analysis of the results. Wrote the article and agreed on the journal to which the article was submitted. J Valdespino-Valdes: Acquisition of data, analysis of the results. Wrote the article and agreed on the journal to which the article was submitted. A Gómez-De León: Data analysis and interpretation of the results. Critically reviewed the article and agreed on the journal to which the article was submitted. PR Colunga-Pedraza: Substantially revised the article and agreed on the journal to which the article was submitted. CH Gutiérrez-Aguirre: Conception of the study, data interpretation. Drafted the article and agreed on the journal to which the article was submitted. OG Cantú-Rodríguez: Study design, data interpretation. Critically reviewed the article and agreed on the journal to which the article was submitted. D Gómez-Almaguer: Interpretation of the findings. Critically reviewed the article and agreed on the journal to which the article was submitted. All authors declare that they reviewed and agreed on all versions of the article before submission, during revision, the final version accepted for publication, and any significant changes introduced at the proofing stage. Also, all Authors agreed to take responsibility and be accountable for the contents of the article and to share responsibility to resolve any questions raised about the accuracy or integrity of the published work.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

We want to thank Sergio Lozano-Rodríguez, MD for his critical manuscript review. Partial data of this work were presented as a poster in the COSTEM Congress, Berlin, 2023.

Data availability statement

The data that support the findings of this study are available from the corresponding author, [JCJP], upon reasonable request.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/17474086.2024.2305372

Additional information

Funding

This paper was not funded.