Melphalan-based conditioning with post-transplant cyclophosphamide for peripheral blood stem cell transplantation: donor effect
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.
Authors
- Yazeed Samara
- Eileen Smith (ORCID: https://orcid.org/0000-0003-2789-5046)
- Vaibhav Agrawal (ORCID: https://orcid.org/0000-0002-6383-3777)
- Vinod A. Pullarkat (ORCID: https://orcid.org/0000-0001-9129-3424)
- Sally Mokhtari
- Amanda Blackmon (ORCID: https://orcid.org/0000-0003-0732-0800)
- Tamer Adel Othman (ORCID: https://orcid.org/0000-0001-6376-4495)
- Ahmed Aribi (ORCID: https://orcid.org/0000-0003-2497-3176)
- Stephen J. Forman (ORCID: https://orcid.org/0000-0002-2803-4152)
- Ibrahim Taha Aldoss (ORCID: https://orcid.org/0000-0001-9564-4498)
- Guido Marcucci
- Monzr M. Al Malki (ORCID: https://orcid.org/0000-0001-8226-471X)
- Pamela S. Becker (ORCID: https://orcid.org/0000-0001-6235-9463)
- Anthony Stein
- Shukaib Arslan (ORCID: https://orcid.org/0000-0002-8447-9607)
- Andrew Artz (ORCID: https://orcid.org/0000-0003-0803-9607)
- Brian Ball (ORCID: https://orcid.org/0000-0001-8625-7023)
- Karamjeet Sandhu (ORCID: https://orcid.org/0000-0001-8024-8484)
- Amandeep Salhotra (ORCID: https://orcid.org/0000-0002-9302-5041)
- Paul Koller (ORCID: https://orcid.org/0000-0003-3830-5320)
- Haris Ali (ORCID: https://orcid.org/0000-0002-9728-7292)
- Hoda Pourhassan (ORCID: https://orcid.org/0000-0003-3862-4612)
- Salman Otoukesh (ORCID: https://orcid.org/0000-0002-7782-8805)
- Idoroenyi Amanam (ORCID: https://orcid.org/0000-0003-4819-4628)
- Ryotaro Nakamura (ORCID: https://orcid.org/0000-0002-9082-0680)
- Dongyun Yang (ORCID: https://orcid.org/0000-0003-0736-4977)
- F. Marc Stewart
Institutions
- City Of Hope National Medical Center (US)
- City of Hope (US)
Publication Details
- Journal
- Bone Marrow Transplantation
- Published
- 2025-02-27
- DOI
- https://doi.org/10.1038/s41409-025-02523-3
- Citations
- 1
- Primary Topic
- Hematopoietic Stem Cell Transplantation
- Type
- article
- Field-Weighted Citation Impact
- 1.77