Clinical Scorecard: Utilization Patterns of Grafts in Real-World Settings Following CTN-1101: A Registry Analysis Comparing Haploidentical and Umbilical Cord Blood Sources

At a Glance

Key Highlights

• CTN-1101 trial showed no significant difference in two-year progression-free survival between haplo-BM and double unrelated UCB but better two-year overall survival with haplo-BM (57% vs 46%, p=0.04).
• Five-year survival favored haplo-BM over double UCB in both trial and non-trial patients (47% vs 36%, p=0.012).
• Real-world data from 2010-2022 show increased utilization of haplo transplants and decreased use of UCB transplants in adult patients consistent with CTN-1101 findings.

Guideline-Based Recommendations

Diagnosis

• Select adult patients aged 18-70 years with hematologic malignancies eligible for allogeneic HCT.
• Exclude patients with solid tumors, non-malignant disorders, or multiple graft sources.

Management

• Consider haploidentical bone marrow or peripheral blood stem cell grafts as preferred donor sources when matched related or unrelated donors are unavailable.
• Use umbilical cord blood transplantation as an alternative graft source, acknowledging lower overall survival compared to haplo-BM.

Monitoring & Follow-up

• Monitor overall survival and progression-free survival post-transplant, with attention to graft source impact.
• Assess demographic factors (age, sex, race/ethnicity) for potential influence on graft utilization and outcomes.

Risks

• Recognize potential differences in survival outcomes between graft sources.
• Consider resource implications of graft source selection and clinical trial data translation into practice.

Patient & Prescribing Data

Adult patients aged 18-70 years undergoing first allogeneic HCT for hematologic malignancies in the United States

Haploidentical grafts (both bone marrow and peripheral blood stem cells) have increased in utilization post-CTN-1101 trial publication, reflecting improved survival outcomes compared to umbilical cord blood grafts.

Clinical Best Practices

• Adopt haploidentical grafts preferentially over umbilical cord blood for eligible adult patients lacking matched donors.
• Use registry data to monitor real-world graft utilization trends and outcomes.
• Incorporate demographic factors into graft source selection and anticipate differential utilization patterns.
• Support resource-intensive phase 3 trials to inform clinical practice changes.

References

• Blood and Marrow Transplant Clinical Trials Network (CTN) 1101 Trial
• Center for International Blood and Marrow Transplant Research (CIBMTR) Annual Report
• Phase 2 Studies Comparing Haploidentical and Umbilical Cord Blood Transplants