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<p>The data on outcomes of haploidentical hematopoietic stem cell transplantation (haplo-HSCT) with Fludarabine–Total Body Irradiation (Flu-TBI) based myeloablative conditioning from resource-limited countries is sparse. This study evaluated Flu-TBI based myeloablative conditioning with post-transplant cyclophosphamide (PTCy) for haplo-HSCT, focusing on graft-versus-host-disease (GVHD)-free relapse-free survival (GRFS), relapse-free survival (RFS), non-relapse mortality (NRM), and overall survival (OS). We retrospectively analyzed 42 patients at a South Indian tertiary cancer center from August 2015 to May 2024. Patients, mostly with acute leukemia, received Flu-TBI‚ and PTCy for GVHD prophylaxis. Data on characteristics, toxicities, GVHD, and outcomes were collected. Survival was assessed via the Kaplan-Meier method. Median age was 16.5 years (60% male). The 2-year GRFS was 41.1%, RFS was 50.6%, and OS was 52.0%. Day 100 NRM occurred in 28.5% (<i>n</i> = 12). Acute GVHD (grade 3–4) and chronic GVHD (extensive) incidences were 14% and 10%, respectively. Severe hemorrhagic cystitis, related to BK-virus reactivation, affected only 7% (<i>n</i> = 3). Multivariate analysis showed that female donors were associated with significantly worse GRFS (HR 2.58, 95%CI 1.1–6.2, <i>p</i> = 0.03). Flu-TBI with PTCy is an effective haplo-HSCT regimen, yielding acceptable survival and low hemorrhagic cystitis risk. Female donors notably reduce GRFS, suggesting male donor preference when feasible.</p>

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Fludarabine – Total Body Irradiation-Based Myeloablative Conditioning for Haploidentical Hematopoietic Stem Cell Transplantation: A 10-Year Single Centre Real-World Analysis

  • 期刊论文

  • 发表日期：

    2025年6月20日

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  • Pragadeesh Thamaraiselvan,
  • Krishnarathinam Kannan,
  • Jayachandran Perumal Kalaiyarasi,
  • Gargi Das,
  • Parathan Karunakaran,
  • Prasanth Srinivasan,
  • Nikita Mehra,
  • Balaji Thiruvengadam Kothandan,
  • Venkatraman Radhakrishnan

摘要

The data on outcomes of haploidentical hematopoietic stem cell transplantation (haplo-HSCT) with Fludarabine–Total Body Irradiation (Flu-TBI) based myeloablative conditioning from resource-limited countries is sparse. This study evaluated Flu-TBI based myeloablative conditioning with post-transplant cyclophosphamide (PTCy) for haplo-HSCT, focusing on graft-versus-host-disease (GVHD)-free relapse-free survival (GRFS), relapse-free survival (RFS), non-relapse mortality (NRM), and overall survival (OS). We retrospectively analyzed 42 patients at a South Indian tertiary cancer center from August 2015 to May 2024. Patients, mostly with acute leukemia, received Flu-TBI‚ and PTCy for GVHD prophylaxis. Data on characteristics, toxicities, GVHD, and outcomes were collected. Survival was assessed via the Kaplan-Meier method. Median age was 16.5 years (60% male). The 2-year GRFS was 41.1%, RFS was 50.6%, and OS was 52.0%. Day 100 NRM occurred in 28.5% (n = 12). Acute GVHD (grade 3–4) and chronic GVHD (extensive) incidences were 14% and 10%, respectively. Severe hemorrhagic cystitis, related to BK-virus reactivation, affected only 7% (n = 3). Multivariate analysis showed that female donors were associated with significantly worse GRFS (HR 2.58, 95%CI 1.1–6.2, p = 0.03). Flu-TBI with PTCy is an effective haplo-HSCT regimen, yielding acceptable survival and low hemorrhagic cystitis risk. Female donors notably reduce GRFS, suggesting male donor preference when feasible.