Dr. Jain on Transplantation from Haploidentical Donors in Myelofibrosis

Tania Jain, MBBS, director, Adult Chimeric Antigen Receptor T-cell Therapy Program for Hematological Malignancies, Sidney Kimmel Comprehensive Cancer Center, Assistant Professor of Oncology, Johns Hopkins Medicine, discusses post-transplant cyclophosphamide-based transplantation from haploidentical donors (HD) in myelofibrosis.

Data were presented at the 2023 Transplantation and Cellular Therapy Meetings from a retrospective study comparing the outcomes of 4 common donor types in myelofibrosis: matched sibling donor (MDS), matched unrelated (MUD) donor, mismatched unrelated donor (MMUD), and HD with post-transplant cyclophosphamide. Findings showed that overall survival (OS) favored patients with MSD; however, investigators aimed to better understand this difference, Jain says. In a multivariate analysis, investigators examined OS within the first 3 months post-transplant and the overall OS, Jain notes.

The significant difference in OS was found within the first 3 months, which investigators linked to higher instances of non-relapse mortality in patients in the MUD, MMUD, and HD arms, Jain explains. Beyond 3 months, there was no significant difference in OS, Jain adds. Moreover, there was no difference in relapse and notably, occurrence of graft-vs-host disease was better with patients who had an HD or MUD, Jain says.

A surprising result was high graft failure rate in patients with an HD, Jain continues, adding that investigators want to explore these findings deeper to better understand whether this is true a problem, or whether these data were a result of the growing pains following the introduction of HD to practice over the past decade, Jain notes.

HD came into practice around 2008, upon the publication of a Johns Hopkins research paper, and in 2013, the first haploidentical donors became evident in myelofibrosis, based on the registry data, Jain says. To better understand if rates of graft failure improved with increased experienced with HD, investigators are capturing a time-variable outcome in terms of graft failure, Jain concludes.