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Outcomes of salvage haploidentical transplantation using posttransplant cyclophosphamide for graft failure following allogeneic hematopoietic stem cell transplantation

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Abstract

Haploidentical donors have emerged as an alternative donor source for salvage stem cell transplantation (SCT) after graft failure; however, data regarding salvage haploidentical SCT using posttransplant cyclophosphamide (PTCy) are limited. Using nationwide data (2011–2019), we retrospectively investigated transplant outcomes after salvage haploidentical SCT using PTCy for graft failure (n = 33, median age 34 years). The total dose of PTCy was 75–100 mg/kg (standard dose) in 26 patients (78.8%) and 40–50 mg/kg (lower dose) in 5 patients (15.2%). The neutrophil engraftment rate at 30 days was 81.8%. One-year overall survival (OS) and non-relapse mortality (NRM) rates were 47.4% and 46.0%, respectively. The standard-dose group exhibited better OS (61.1% vs. 0.0% at 1 year, P = 0.022) and NRM (35.1% vs. 80.0% at 1 year, P = 0.052) than the lower-dose group. Moreover, the standard-dose group was less prone to both grades II–IV (11.5% vs. 40.0%) and III–IV (0.0% vs. 40.0%) acute graft-versus-host disease (GVHD). Use of cyclophosphamide in previous SCT and conditioning did not affect OS or NRM. In conclusion, haploidentical salvage SCT using PTCy offers promising survival outcomes. Prospective studies are required to validate the efficacy of salvage haploidentical SCT using PTCy.

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Data availability

Clinical data were provided by the Transplant Registry Unified Management Program 2 of the Japanese Data Center for Hematopoietic Cell Transplantation. Restrictions are applicable to the availability of the data, which were used under license for this study.

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Acknowledgements

The authors thank all the physicians and staff at the transplant centers who provided the clinical data to the Transplant Registry Unified Management Program of the Japan Society of Hematopoietic Cell Transplantation. The authors also thank Enago (www.enago.jp) for the English language review. KH, YN, MK, AS, SF and Hideki N designed this study on behalf of the transplant complication working group in the Japan Society for Hematopoietic Cell Transplantation. KH performed all analyses and wrote the first draft. Hirohisa N, MT, MA, MO, YH, TI, and YA contributed to data interpretation and correction of the draft. All authors approved the final manuscript.

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Authors and Affiliations

  1. Department of Hematology and Oncology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1143, Japan

    Kaito Harada, Masako Toyosaki & Makoto Onizuka

  2. Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan

    Yuho Najima

  3. Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan

    Motohiro Kato

  4. Department of Hematology, Osaka International Cancer Institute, Osaka, Japan

    Shigeo Fuji

  5. Department of Hematology, Tokyo Women’s Medical University, Tokyo, Japan

    Akihito Shinohara

  6. Department of Hematology, Osaka City University Hospital, Osaka, Japan

    Hirohisa Nakamae

  7. Department of Pediatrics, St. Luke’s International Hospital, Tokyo, Japan

    Miho Ashiarai

  8. Cancer Immunotherapy/Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan

    Yoshiko Hashii

  9. Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan

    Tatsuo Ichinohe

  10. Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan

    Yoshiko Atsuta

  11. Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Nagakute, Japan

    Yoshiko Atsuta

  12. Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan

    Hideki Nakasone

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  1. Kaito Harada
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Correspondence to Kaito Harada.

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Our study protocol was approved by the institutional review board of the Tokai University School of Medicine.

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Harada, K., Najima, Y., Kato, M. et al. Outcomes of salvage haploidentical transplantation using posttransplant cyclophosphamide for graft failure following allogeneic hematopoietic stem cell transplantation. Int J Hematol 116, 744–753 (2022). https://doi.org/10.1007/s12185-022-03405-w

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  • DOI: https://doi.org/10.1007/s12185-022-03405-w

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