Haploidentical donor hematopoietic cell transplantation for myelodysplastic/myeloproliferative overlap neoplasms: results from a North American collaboration
Tania Jain,
Hua-Ling Tsai,
Hany Elmariah,
Pankit Vachhani,
Theodoros Karantanos,
Sarah A Wall,
Lukasz P. Gondek,
Asad Bashey,
Alla Keyzner,
Roni Tamari,
Michael R. Grunwald,
Sameem Abedin,
Kalyan VG Nadiminti,
Madiha Iqbal,
Aaron T Gerds,
Auro Viswabandya,
Shannon R McCurdy,
Monzr M. Al Malki,
Ravi Varadhan,
Haris Ali,
Vikas Gupta,
Richard J. Jones,
Salman Otoukesh
Affiliations
Tania Jain
Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, 1650 Orleans street, Baltimore, MD, USA 21287
Hua-Ling Tsai
Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 550 North Broadway, Baltimore, MD, USA 21287
Hany Elmariah
Department of Bone Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, USA 33612
Pankit Vachhani
Division of Hematology and Oncology, O’Neal Comprehensive Cancer Center, University of Alabama, 1802 6th Ave S, Birmingham, AL, USA 35294
Theodoros Karantanos
Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, 1650 Orleans street, Baltimore, MD, USA 21287
Sarah A Wall
Division of Hematology, The Ohio State University – James Comprehensive Cancer Center, 1800 Cannon Drive, 11th Floor, Columbus, OH, USA 43210
Lukasz P. Gondek
Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, 1650 Orleans street, Baltimore, MD, USA 21287
Asad Bashey
Blood and Marrow Transplant Program, Northside Hospital, 5670 Peachtree Dunwoody Road, Atlanta, GA, USA 30342
Alla Keyzner
The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place P.O. Box 1410, New York, NY, USA 10029
Roni Tamari
Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Department of Medicine, Weill Cornell Medical College, 1275 York avenue, New York, NY, USA 10065
Michael R. Grunwald
Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Drive, LCI Building 2, Suite 60100, Charlotte, NC, USA 28204
Sameem Abedin
Division of Hematology/Oncology, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI, USA 53226
Kalyan VG Nadiminti
Division of Hematology, Medical Oncology and Palliative Care, Department of Medicine, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI, USA 53792
Madiha Iqbal
Department of Hematology-Oncology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, USA 32224
Aaron T Gerds
Department of Hematology and Medical Oncology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA 44195
Auro Viswabandya
Princess Margaret Cancer Centre, University of Toronto, 610 University Ave, Toronto, Canada M5G 2C1
Shannon R McCurdy
University of Pennsylvania, 3400 Civic center road, 12 South Pavilion, Philadelphia, PA 19104
Monzr M. Al Malki
Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, 1500 East Duarte Road, Duarte, CA, USA 91010
Ravi Varadhan
Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 550 North Broadway, Baltimore, MD, USA 21287
Haris Ali
Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, 1500 East Duarte Road, Duarte, CA, USA 91010
Vikas Gupta
Princess Margaret Cancer Centre, University of Toronto, 610 University Ave, Toronto, Canada M5G 2C1
Richard J. Jones
Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, 1650 Orleans street, Baltimore, MD, USA 21287
Salman Otoukesh
Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, 1500 East Duarte Road, Duarte, CA, USA 91010
Haploidentical donors offer a potentially readily available donor, especially for non-White patients, for hematopoietic cell transplantation (HCT). In this North American collaboration, we retrospectively analyzed outcomes of first HCT using haploidentical donor and post-transplantation cyclophosphamide (PTCy) in myelodysplastic syndrome/myeloproliferative neoplasm (MDS/MPN) overlap neoplasms (MDS/MPN). We included 120 consecutive patients who underwent HCT using a haploidentical donor for MDS/MPN across 15 centers. Median age was 62.5 years and 38% were of non-White/Caucasian ethnicity. The median follow-up was 2.4 years. Graft failure was reported in seven of 120 (6%) patients. At 3 years, nonrelapse mortality (NRM) was 25% (95% confidence interval [CI]: 17-34), relapse 27% (95% CI: 18-36), grade 3-4 acute graftversus- host disease 12% (95% CI: 6-18), chronic graft-versus-host disease requiring systemic immunosuppression 14% (95% CI: 7-20), progression-free survival (PFS) 48% (95% CI: 39-59), and overall survival (OS) 56% (95% CI: 47-67). On multivariable analysis, NRM was statistically significantly associated with advancing age at HCT (per decade increment, subdistribution hazard ratio [sdHR] =3.28; 95% CI: 1.30-8.25); relapse with the presence of mutation in EZH2/RUNX1/SETBP1 (sdHR=2.61; 95% CI: 1.06-6.44); PFS with advancing age at HCT (per decade increment, HR=1.98, 95% CI: 1.13-3.45); and OS with advancing age at HCT (per decade increment, HR=2.01; 95% CI: 1.11-3.63) and splenomegaly at HCT/prior splenectomy (HR=2.20; 95% CI: 1.04-4.65). Haploidentical donors are a viable option for HCT in MDS/MPN, especially for those disproportionately represented in the unrelated donor registry. Hence, donor mismatch should not preclude HCT for patients with MDS/MPN, an otherwise incurable malignancy. In addition to patient age, disease-related factors including splenomegaly and high-risk mutations dominate outcomes following HCT.
