Outcomes after 7/8 and <7/8 mismatched unrelated donor PBSC transplantation with PTCy: results from the ACCESS trial
Year: 2026
Type: article
Abstract: ACCESS is a prospective, multicenter phase II trial evaluating peripheral blood stem cell (PBSC) transplantation using 4-7/8 HLA-mismatched unrelated donors (MMUD) with post-transplant cyclophosphamide (PTCy), tacrolimus, and mycophenolate. Adults undergoing first HCT with myeloablative (MAC) or reduced-intensity/nonmyeloablative (RIC/NMA) conditioning were enrolled, with donors aged 18-35 years and matched at 4/8-7/8 HLA loci by high-resolution typing. This expanded analysis includes all enrolled adult PBSC recipients, including the protocol-specified RIC/NMA cohort expansion, to improve precision of outcome estimates and provide descriptive analyses by HLA match level. Among 268 adults, 183 received 7/8 and 85 received <7/8 MMUD grafts; 82.4% of the <7/8 cohort received 6/8 grafts. Median follow-up among survivors was 11.9 months. At 1-year, overall survival was 78.6% (95% CI, 71.9-83.9) in the 7/8 cohort and 85.6% (95% CI, 76.0-91.5) in the <7/8 cohort. One-year relapse, non-relapse mortality, and GVHD-free relapse-free survival were 17.1%, 13.7%, and 51.1% versus 22.8%, 8.4%, and 54.6%, respectively. The cumulative incidence of grade II-IV and grade III-IV acute GVHD by day 100 was 36.6% and 7.7% in the 7/8 cohort versus 28.3% and 5.9% in the <7/8 cohort. Moderate-to-severe chronic GVHD at 1 year was 11.3% versus 7.7%, respectively. Among adult ACCESS recipients treated on a uniform young-donor PBSC/PTCy platform, short-term outcomes with predominantly 6/8 MMUD transplantation were encouraging. Because donor match level was not prospectively assigned and between-group comparisons were exploratory, these findings are descriptive and should not be interpreted as establishing equivalence with 7/8 MMUD transplantation. (Registered as NCT04904588 at CT.gov).
Source: Blood Advances
Authors: Antonio Martin Jimenez Jimenez, Joseph Stanek, Brent R Logan, Erin Leckrone, Heather E. Stefanski, Jeffery J. Auletta, Stephen R. Spellman, Craig Malmberg, Medhat Askar, Rachel N. Cusatis, Brian C. Shaffer, Dipenkumar Modi, Farhad Khimani, Mahasweta Gooptu, Mehdi Hamadani, Martin Maiers, Stephanie Bo-Subait, Javier Bolaños-Meade, Uttam Rao, Jordan Milner, Ramzi Abboud, Katarzyna Joanna Jamieson, George Carrum, Bhagirathbhai Dholaria, William J. Hogan, Ran Reshef, Satyajit Kosuri, Rachel J. Cook, Karen Ballen, Alison W. Loren, Karilyn Larkin, Sally Arai, Muna Qayed, Sung Won Choi, Larisa Broglie, Bronwen E. Shaw, Steven M. Devine, Monzr M. Al Malki
Institutions: University of Miami, National Marrow Donor Program, Medical College of Wisconsin, Memorial Sloan Kettering Cancer Center, Wayne State University, The Barbara Ann Karmanos Cancer Institute, Moffitt Cancer Center, Dana-Farber Cancer Institute, Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, St David's Medical Center, University of Florida Health, University of Florida, Washington University in St. Louis, University of North Carolina Hospitals, Houston Methodist, Baylor College of Medicine, Vanderbilt University Medical Center, Mayo Clinic, Columbia University Irving Medical Center, University of Chicago, Oregon Health & Science University, OHSU Knight Cancer Institute, University of Virginia Health System, University of Virginia, University of Pennsylvania, The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Stanford Health Care, Emory University, Children's Healthcare of Atlanta, University of Michigan, City Of Hope National Medical Center
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,800
OpenAlex ID: W7203780286
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