Haploidentical Stem Cell Transplantation: Half Match but More Hope!-Single Centre Experience from Western India.

ABSTRACT

With the success of post-transplant cyclophosphamide based platform and improved clinical care, the number of haploidentical stem cell transplants (HaploSCT) have surged over the last decade. However, data from India is scarce. We aimed to evaluate the outcome of haploSCT at our centre. Since the inception of government schemes, many patients at our centre are able to undergo transplantation at subsidized cost. We conducted a retrospective analysis of the haploidentical transplants performed between January 2015 and November 2022. Fifty patients were eligible for this study. Patient details were obtained from case files. The graft versus host disease (GVHD) prophylaxis was post-transplant Cyclophosphamide (PTCy) with Mycophenolate-mofetil and Cyclosporine/tacrolimus/sirolimus. All patients were transfused peripheral blood stem cells from donors. Post-transplant, patients continued regular follow up as per schedule. Supportive care was given as per unit protocol. Overall survival (OS) was calculated using the Kaplan-Meier method. Fifty patients underwent haploSCT. A total of fifty patients with a median age of 20 years (range 3-53 years) underwent haploidentical HSCT from a family donor. Twenty three (46%) patients were > 18 years age and 82% were males. Indications for transplant included both benign and malignant hematological diseases. Most common conditioning regimen used was Fludarabine + Busulphan + Cyclophosphamide (n = 38, 76%). Thirty five patients (70%) engrafted successfully. In the patients who had successful engraftment, the median time to neutrophil engraftment was 16 days (range 10-20 days) and platelet engraftment was 18 days (range 10-32). Fourteen patients developed acute GVHD (28%), and three patients developed chronic GVHD (6%). The median follow-up was 30 months and the two-year OS was 43% with a median OS of 17 months. Twenty-one (adult = 9, pediatric = 12) out of 50 patients (42%) are alive and on regular follow-up. HaploSCT with a PTCy platform is a cost-effective, promising modality of treatment in patients who have no suitable matched donors and are not affording matched unrelated transplants. At our centre, we were able to achieve acceptable results with use of generic medications at affordable cost. Transplant Related Mortality (TRM) rates were comparable to other centres, however, multi-drug resistant bacterial infection remains a challenge in performing haploidentical HSCT in developing countries.