Work

Reduced Healthcare Resource Utilization in TCR Αβ/CD19-Depleted Haploidentical Compared to Matched Related and Unrelated Donor Hematopoietic Cell Transplant in First 100 Days for Pediatric Hematologic Malignancies

Year: 2024

Type: article

Abstract: Bulk of expenses for allogeneic hematopoietic cell transplant (HCT) results from healthcare resource utilization (HCRU) in first 100 days post-HCT. (Majhail et al, Pediatric Blood and Cancer, 2010;54:138–143) TCR αβ T cell/CD19-depleted (A/B TCD) haploidentical HCT (haplo-HCT) is a promising transplant strategy but cost of graft manipulation is a significant limitation when compared to non-TCD matched related donor (MRD) or matched unrelated donor (MUD) HCT. A/B TCD haplo-HCT balances the cost of graft manipulation by significantly reducing the HCRU in first 100 days post-HCT when compared to MRD or MUD HCT. To compare HCRU in first 100 days after myeloablative conditioning (MAC) based transplants in A/B TCD haplo-HCT, MRD and MUD HCT patients. This retrospective study included patients aged ≤18 years of age with hematologic malignancies (ALL, AML and MDS) undergoing myeloablative HCT. We analyzed initial (transplant to discharge) and total (initial plus readmission days) inpatient length of stay (LOS) in first 100 days after A/B TCD (N=12), MRD (N=11) and MUD (N=18) HCT. A/B TCD HCTs were done during February 2021- September 2023. MRD and MUD HCTs were done during January 2015- September 2023. Graft source for all A/B TCD HCTs was peripheral blood. Bone marrow was used for 8/11 (73%) MRD and 16/18 (89%) MUD HCTs. Medians and interquartile range were used for comparing demographic and clinical characteristics. Comparisons across groups were made using Kruskal-Wallis test for quantitative variables, and Fisher's Exact test for categorical variables. Graft failure and second transplants were excluded. Compared to MRD and MUD HCTs, A/B TCD haplo-HCT group experienced shortest duration of initial LOS (median for MRD 47 vs MUD 40 vs A/B TCD 39 days; p=0.44). Similarly, total inpatient (median for MRD 50 vs MUD 60 vs A/B TCD 43 days; p=0.09) and PICU LOS (median was 0 days for MRD and A/B TCD versus 1 day for MUD p=0.056) was shortest and neutrophil engraftment was fastest in A/B TCD group (median MRD 20 vs MUD 21 days vs A/B TCD 10 days; p<0.001) (Figures 1-3, engraftment not shown). Readmission and ICU admission rates were also the lowest in A/B TCD HCT. This translated to A/B TCD HCT group spending highest number of days alive and outside the hospital (median MRD 50 days, MUD 40 days, A/B TCD 57 days; p=0.09) in first 100 days post-HCT. A/B TCD HCT group had 0% relapse before day 100 compared to 18% in MRD and 17% in MUD group. Compared to MRD/MUD HCT, A/B TCD HCT reduces HCRU in first 100 days post-HCT by reducing duration of initial, total and PICU LOS, partly because of significantly faster hematopoietic recovery. A planned analysis of number of days of transfusion/growth factor support, total parental nutrition, infection rates, GVHD rates and severe complications rates and need for intensive care like mechanical ventilation or dialysis is underway.

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.jtct.2023.12.318