Melphalan-based conditioning with post-transplant cyclophosphamide for peripheral blood stem cell transplantation: donor effect
Year: 2025
Type: article
Study design: Observational Study
Abstract: Fludarabine and melphalan (FM) conditioning offers effective disease control with an acceptable toxicity profile. Post-transplant cyclophosphamide (PTCy) for graft-versus-host disease (GVHD) prophylaxis has improved transplant outcomes. We retrospectively reviewed patients receiving FM-based transplants with PTCy at City of Hope. Of 248 patients included, 89 (35.9%) received hematopoietic cell transplant (HCT) from a matched related/unrelated donor (MRD/MUD), 118 (47.6%) from a haploidentical (HID) donor, and 49 (19.8%) from a mismatched unrelated donor (MMUD). There were no differences in acute and chronic GVHD based on donor type. The 2-year overall survival (OS) for patients receiving HID, MMUD, and MRD/MUD was 58%, 55%, and 70%; disease-free survival (DFS) was 52%, 48%, and 66%; and graft-versus-host/relapse-free survival (GRFS) were 48%, 40%, and 59%, respectively. OS, DFS, and GRFS were similar regardless of donor type on multivariable analysis. However, donor age ≥35 years was associated with lower OS and GRFS and higher 2-year non-relapse mortality (NRM) on multivariable analysis across all patients, regardless of donor type. FM with PTCy appears to produce similar outcomes between MRD/MUD, MMUD, and HID when adjusting for donors <35 years, and donor age seems to be the most important factor when selecting a donor with this regimen.
Source: Bone Marrow Transplantation
Authors: Paul B. Koller, Tamer Othman, Dongyun Yang, Sally Mokhtari, Yazeed Samara, Amanda Blackmon, Vaibhav Agrawal, Hoda Pourhassan, Brian J. Ball, Idoroenyi Amanam, Shukaib Arslan, Salman Otoukesh, Karamjeet S. Sandhu, Ibrahim Aldoss, Haris Ali, Amandeep Salhotra, Ahmed Aribi, Andrew Artz, Pamela S. Becker, Vinod Pullarkat, Forest Marc Stewart, Eileen P. Smith, Anthony Stein, Guido Marcucci, Stephen J. Forman, Ryotaro Nakamura, Monzr M. Al Malki
Institution: City Of Hope National Medical Center
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,990
OpenAlex ID: W4408062018