GVHD Prophylaxis Expands Graft Source Options for MDS

Ronald L. Paquette, MD, clinical director of the Stem Cell and Bone Marrow Transplant Program at Cedars-Sinai Medical Center and Samuel Oschin Cancer Center, discusses the selection of graft source for bone marrow and stem cell transplants in patients with myelodysplastic syndrome (MDS).

Paquette says that his treatment center prefers to perform peripheral blood stem cell transplant over bone marrow transplant because the risk of chronic graft-versus-host disease (GVHD) requiring treatment is only about 10%. Post-transplant cyclophosphamide prophylaxis is used in all transplants at Paquette’s center, whether they are unrelated donors, haplo-identical donors, or fully matched donors, greatly improving outcomes for patients by reducing the risk of chronic GVHD.

About 85% of transplants in Paquette’s experience are performed using half-matched donors. While stem cell transplants from fully matched donors such as siblings have better outcomes for patients with MDS, older patients may not have healthy siblings who are suitable donors, and more often patients’ children who are haploidentical are used as donor, still offering good outcomes due to GVHD prophylaxis.

TRANSCRIPTION:

0:08 | In terms of graft source, we preferentially use peripheral blood stem cells here because the risk of chronic GVHD that requires therapy at our center is somewhere around 10%. And so using bone marrow to try to reduce the risk of chronic GVHD seems not to be necessary in the age of post-transplant cyclophosphamide.

That leads to GVHD prophylaxis. Our center uses post-transplant cyclophosphamide for all of our transplants, regardless of if they're fully matched related donors, unrelated donors, or haploidentical donors. We use all of those graft sources, and because MDS patients, as I've alluded to, are generally older, we oftentimes will use [their] children as donors. In fact, I think about 85% of our transplants are performed using half-matched donors. Although the outcomes are perhaps numerically a little bit lower than a fully matched related donor, someone who is 70 is not going to have a suitable donor who's a fully matched sibling, so it is a very practical solution to transplanting patients who are older with MDS is to use 1 of their children who is haploidentical.