Donor-specific transplant outcomes from BMT CTN 1702: a multicenter prospective biologic assignment trial
Year: 2026
Type: article
Abstract: ABSTRACT: Newer approaches to control alloreactivity may produce similar transplant outcomes using HLA-mismatched donors vs HLA-matched unrelated donors (MUD). However, prospective comparisons are lacking. BMT CTN 1702 used a donor search prognosis score to assign patients to an 8/8 HLA MUD or the center's preference of haploidentical related donors (HAPLO), mismatched unrelated donors (MMUD), or umbilical cord blood (UCB). Outcomes of MUD were compared to HAPLO, MMUD, and UCB transplantation after adjusting for covariates. Patients (n = 1179 [93% adults]) underwent transplantation with MUD (n = 772), HAPLO (n = 254), MMUD (n = 112), and UCB (n = 41) at a median of 3.7, 3.4, 3.9, and 3.8 months from enrollment. Posttransplant cyclophosphamide (PTCy) was used in 23.9%, 83.9%, 65.2%, and 0% of MUD, HAPLO, MMUD, and UCB. In multivariate analyses, compared to MUD, survival was lower for UCB (hazard ratio [HR], 2.65; P< .001) but not statistically different for HAPLO and MMUD (HRs, 1.08 and 1.18, respectively). Relapse risk was not significantly different by donor, but treatment-related mortality (HR, 3.31; P< .001) and disease-free survival (HR, 1.99; P = .002) were inferior for UCB but not different for HAPLO and MMUD than MUD. In patients who received PTCy, HAPLO and MMUD were associated with increased grade 3 or 4 acute graft-versus-host disease (GVHD; HR, 2.39 [P = .017] and 2.53 [P = .038], respectively) and chronic GVHD (HR, 1.71 for both; P = .028 and .080) than MUD, but other outcomes were not different. HAPLO or MMUD may be used to expedite transplantation when finding MUD is unlikely. This study was registered at www.clinicaltrials.gov as NCT03904134.
Source: Blood Advances
Authors: Asad Bashey, Brent Logan, LaQuisa Hill, Heather Symons, Nosha Farhadfar, Michael R. Grunwald, Joseph Pidala, Jason G. Dehn, Claudio Brunstein, Sally Arai, Eric Leifer, Naya He, Bronwen E. Shaw, Mark Juckett, Steven Devine, Joseph Uberti, Peter Westervelt, Samer A. Srour, Iskra Pusic, Sumithira Vasu, Brandon Hayes-Lattin, Stefan O. Ciurea, Mary M. Horowitz, Stephanie J. Lee, William J. Hogan
Institutions: Northside Hospital, Medical College of Wisconsin, Baylor College of Medicine, Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Methodist Healthcare, Levine Cancer Institute, Moffitt Cancer Center, National Marrow Donor Program, Cleveland Clinic, Stanford Medicine, Stanford University, National Heart, Lung, and Blood Institute, University of Minnesota, The Barbara Ann Karmanos Cancer Institute, The University of Texas MD Anderson Cancer Center, Washington University in St. Louis, The Ohio State University, Oregon Health & Science University, OHSU Knight Cancer Institute, University of California, Irvine, Fred Hutch Cancer Center, Mayo Clinic
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,800
OpenAlex ID: W7164014635