Propensity Score Analysis of Conditioning Intensity in Peripheral Blood Haploidentical Hematopoietic Cell Transplantation

Eric Huselton, Michael Slade, Kathryn M. Trinkaus, John F. DiPersio, Peter Westervelt, Rizwan Romee

Research output: Contribution to journalArticle

6 Scopus citations

Abstract

T cell replete HLA-haploidentical hematopoietic cell transplantation (haplo-HCT) with post-transplant cyclophosphamide was originally described using a reduced-intensity conditioning (RIC) regimen. Given that myeloablative conditioning (MAC) is more effective at preventing disease relapse, we compared outcomes of patients receiving MAC and RIC regimens. We evaluated overall survival (OS), disease-free survival (DFS), relapse, nonrelapse mortality (NRM), and graft-versus-host disease (GVHD) of 148 patients that underwent haplo-HCT with either MAC (n = 61) or RIC (n = 87). Propensity score adjustment (PSA) was used to balance baseline characteristics between groups and more effectively compare outcomes based on conditioning intensity. After the PSA analysis, relapse was significantly decreased with MAC (hazard ratio [HR],.47; 95% confidence interval [CI],.31 to.70), but was associated with higher NRM (HR, 1.74; 95% CI, 1.13 to 2.67). OS and DFS were not significantly different between groups (HRs for MAC versus RIC were.87 [95% CI,.64 to 1.18] and.90 [95% CI,.68 to 1.18] for OS and DFS, respectively). Rates of acute and chronic GVHD were not significantly different between groups. This analysis suggests that both MAC and RIC regimens are effective in haplo-HCT and that MAC regimens may result in less relapse in selected patients. These results need to be verified in a larger registry study.

Original languageEnglish
Pages (from-to)2047-2055
Number of pages9
JournalBiology of Blood and Marrow Transplantation
Volume24
Issue number10
DOIs
StatePublished - Oct 2018

Keywords

  • Conditioning intensity
  • Haploidentical transplantation
  • Myeloablative
  • Post-transplant cyclophosphamide
  • Reduced intensity

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