engleski

Duration of hospital stay in the first year post- transplant is similar in patients transplanted from matched unrelated and haploidentical donors - a single institution analysis

Background: With the introduction of post- transplant cyclophosphamide (PT-Cy), haploidentical transplantation became increasingly used. That coupled with the expanding number of indications results in more transplantations done. We analyzed length of initial hospital stay, number of rehospitalizations, hospital days in the first year posttransplant and GVHD incidence comparing transplantation using haploidentical (haplo), matched related (MRD) and unrelated donors (MUD). Methods: In the time period between 1/2012 and 07/2017 we performed a total of 311 allogeneic transplantations in adults: 106 using MRD, 176 using MUD and 29 using haploidentical donor. All patients being transplanted from haploidentical donors received PT Cy. All data were computed using the R package. The link between variables was assessed using Kruskal- Wallis test. The probability of GVHD was calculated using the cumulative incidencemethod and subgroups were compared using the Gray test. Results: Median age of entire group was 47.5 (18.6-67) years ; 43.1 (18.9-63.1), 45.8 (18.5- 65.8) and 49.6 (19.4-67) years for the haplo group. In haplo patients 25 (86%)n received bone marrow (BM), 4 (14%) peripheral blood stem cells (PBSC). Of MRD patients, 31 (29%) and 75 (71%) received BM and PBSC, while of MUD patients 32 (18%) and 144 (82%) received BM and PBSC respectively. In haploidentical group 23 (79%) patients received NMA (“Baltimore”) conditioning, and 6 (21%) standard myeloablative conditioning (MAC). In MRD and MUD group, 63 (59%) and 115 (65%) received reduced intensity conditioning, while 43 (41%) and 61 (35%) received MAC, respectively. With a median follow up of 380 days, overall survival was 50% (95%CI, 43-57%) ; with no significant difference between groups. Median number of days to discharge posttransplant was significantly longer in haplo group, 37 (range 24- 243) vs MRD, 28 (18- 96) or MUD, 28 (15-198) (p=0.0007). During the first year post transplantation patients had an average of 0.86, 0.82 and 1.0 rehospitalization in haplo, MRD and MUD group, respectively, (p=0.22). Median number of hospital days during the first year was significantly shorter after MRD with 35.5 (19-209) days, while it was similar after MUD 44 days (15- 198) and haplo 46 days (25- 243) transplantation (p=0.04). Cumulative incidence of aGVHD II-IV was 33% (95%CI, 28- 38%) for the entire group ; and even though it was highest after MUD (38%, 95% CI 31-45), particularly in comparison to haplo (24%, 95% CI 10-41), statistical significance was not reached. Cumulative incidence of cGVHD was 24% (95%CI, 17-30%), with significantly less cGVHD after haplo (8%, 95% CI 1-23) in comparison to MRD (16%, 95% CI 9-24) and MUD (27%, 95% CI 20- 35), p = 0.03. Conclusions: Haploidentical transplantation program in our center has considerably expanded, and even though the number of haplo transplantations in comparison to other two groups is still modest, we believe this analysis reflects its value. Longer time to discharge in haplo group is surely partly influenced by our cautiousness in the early days of program development, but overall days spent in hospital, less re- hospitalizations and particularly incidence of cGVHD in the haplo group speaks to the overall better quality of life (QoL) post-transplant of our haplo patients. Conflict of interest: Authors declare no conflict of interest

hospital stay duration ; haploidentical transplantation

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