Immunosuppression-Free Status at One-year Post Haploidentical Hematopoietic Cell Transplantation (Haplo) with Post-Transplant Cyclophosphamide (PTCY).

Chronic GVHD among transplant patients who are one-year survivors after matched related or unrelated transplantation was shown to be associated with higher NRM and worse OS. The impact of chronic graft-versus-host disease (GVHD) requiring immunosuppression (IS) on haploidentical (HIDT) recipients with post-transplant cyclophosphamide (PTCY) who have survived one-year post-transplant has not been studied and was investigated for this analysis. A total of 322 adult patients who received HIDT at our center were included in this study. The effect of IS-free status on post-transplant outcomes was assessed. Median follow up for survivors was 63.9 months (18.3-165). A total of 163 patients (65%) were IS free at one-year post HIDT. Baseline characteristics were like those still requiring IS, except for higher female-male donor (28% vs 15 %, P=0.03) and female donors (48% vs 30%, p=0.008). Logistic regression to identify patients more likely to be on IS at 1-year post HIDT showed that female donor sex to be a significant risk (OR 2.11, p=0.009). In a Cox analysis patients requiring IS 1-yr post-transplant had higher NRM (HR 4.18, CI 1.80-6.72, p<0.001) and a trend towards worse DFS (HR 1.59, CI .95-2.66, p=0.08), without impact on OS (HR 1.44, CI 0.90-2.31, p=0.13) or relapse (HR 0.77, CI 0.37-1.61, p=0.49). These results indicate that female donors are significant risk factor for requiring IS at one-year post HIDT. Additionally, chronic GVHD requiring IS at one-year post haplo has no significant effect on relapse but is associated with higher NRM and a trend towards worse DFS.

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