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

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). 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 (<i>n</i> = 107) and oral cyclosporine (CsA) plus methotrexate i.v. for HLA-identical (<i>n</i> = 89) recipients. 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 (<i>p</i> = .011). One-hundred-day cumulative incidence (CI) of aGvHD for haploidentical and HLA-identical was 31% and 33% (<i>p</i> = .84); 2-year CI of cGvHD was 32% and 38% (<i>p</i> = .6), respectively. Haploidentical recipients had less steroid-refractory cGvHD (<i>p</i> = .043). Patients with cGvHD had less 2-year relapse (<i>p</i> = .003); both aGvHD and cGvHD conferred higher OS (<i>p</i> = .010 and <i>p</i> = .001), respectively. Male sex was protective for steroid-refractory cGvHD (<i>p</i> = .028). Acute and chronic GvHD rates were comparable between HLA-identical and haploidentical transplant groups. cGvHD severity was lower in the haploidentical group.

人类白细胞抗原（Human Leukocyte Antigen, HLA）配型可预测异基因造血细胞移植（allogeneic hematopoietic cell transplant, allo-HCT）及移植物抗宿主病（graft-versus-host disease, GvHD）的转归。目前关于采用减低强度预处理（reduced-intensity conditioning, RIC）的门诊HLA相合与单倍体相合造血细胞移植的GvHD转归相关信息仍较为匮乏。本研究对比不同供者类型间的GvHD转归，并报告与GvHD相关的危险因素。本研究纳入的干细胞来源为T细胞富集的外周血。供者分为单倍体相合组（n=107）与HLA相合组（n=89）：单倍体相合受者的GvHD预防方案为移植后环磷酰胺（post-transplant cyclophosphamide, PT-CY）、霉酚酸及钙调磷酸酶抑制剂；HLA相合受者的预防方案为口服环孢素A（cyclosporine A, CsA）联合静脉甲氨蝶呤。本研究共纳入196例造血细胞移植患者。两种移植类型的急性移植物抗宿主病（acute GvHD, aGvHD）与慢性移植物抗宿主病（chronic GvHD, cGvHD）发生率相近。aGvHD严重程度相当，但单倍体相合组的重度cGvHD发生率更低（p=0.011）。单倍体相合组与HLA相合组的aGvHD 100天累积发生率（cumulative incidence, CI）分别为31%与33%（p=0.84）；cGvHD的2年累积发生率分别为32%与38%（p=0.6）。单倍体相合受者的激素难治性cGvHD发生率更低（p=0.043）。合并cGvHD的患者2年复发率更低（p=0.003）；aGvHD与cGvHD均与更优的总生存期（overall survival, OS）相关（分别对应p=0.010与p=0.001）。男性性别是激素难治性cGvHD的保护因素（p=0.028）。HLA相合与单倍体相合移植组的急性及慢性GvHD发生率相近；单倍体相合组的cGvHD严重程度更低。