Despite advances in chemotherapy, allogeneic hematopoietic stem cell transplantation (HSCT) remains best post remission therapy for patients with high risk hematological malignancies.
Haploidentical HSCT is a therapeutic option for patients lacking HLA-matched donor and the need of such therapeutic option is particularly acute in developing countries, lacking unrelated donor registry and or cost is major issue in acquiring unrelated donor progenitor cells.
OBJECTIVE: To assess 1 year overall survival, Engraftment timing, GvHD and relapse in patients diagnosed to have hematological malignancies underwent Haploidentical HSCT.
DESIGN: This is a prospective study conducted by NCI BMT team in different centers included 30 patients with hematological malignancies underwent Haploidentical HSCT starting April 2015 till April 2017 and followed up till April 2018.
PATIENTS OR OTHER PARTICIPANTS: Patients with high risk hematological malignancies, ECOG performance ≤ 2 lacking HLA fully matched donors.
INTERVENTIONS: Pretansplant assessment was done for recipient and donor , Initial VNTR I done prior to transplantation. VNTR II for recipient done upon engraftment .
The donor performed peripheral stem cell mobilization using G-CSF (10microgram/Kg) on day -5 then stem cell infusion on day 0 after Myeloablative regimen (Bu-Cy) or RIC (Flu-Alk) followed by PTCy (Post-transplant Cyclophosphamide) on days +3 and +4 then CSA (Cyclosporine A) and cellcept starting Day +5.
MAIN OUTCOMES MEASURES: To assess : OS at 1 year, Engraftment timing, GvHD and relapse.
RESULTS: Eighteen patients were alive 1 year post-transplant, fifteen patients showed engraftment ranging from Days 18 till Day 25 post-transplant, while 7 showed Engraftment +25 days post-transplant , two showed graft failure .Three developed acute GvHD with one developed chronic GvHD. Four patients relapsed at 4,8,10 and 12 month post-transplant.
CONCLUSIONS: Transplant outcomes using haploidentical donors with PTCy have improved over the past several years and are comparable with outcomes of matched unrelated donors. Haploidentical HSCT is emerging as a fast type of transplant irrespective of the race, offering a therapeutic alternative option, particularly for patients without HLA-compatible donors.