Donor-Specific Transplant Outcomes from BMTCTN 1702: A Multi-Center Prospective Biological-Assignment Trial

Document Type

Article

Publication Date

6-5-2026

Institution/Department

Oncology

Journal Title

Blood advances

Abstract

Newer approaches to control alloreactivity may produce similar transplant outcomes using HLA-mismatched donors versus HLA-matched unrelated donors. However, prospective comparisons are lacking. BMT CTN 1702 used a donor search prognosis score to assign patients without matched sibling donors, to transplant using an 8/8 HLA-matched unrelated donor (MUD) or the center's preference of haploidentical-related (HAPLO), mismatched unrelated (MMUD), or umbilical cord blood (UCB) donors. Outcomes using MUD were compared to HAPLO, MMUD and UCB while adjusting for relevant covariates. Patients (n=1179) (93% adults) underwent transplantation with a MUD (n=772), HAPLO (n=254), MMUD (n=112) and UCB (n=41) at a median of 3.7, 3.4, 3.9 and 3.8 months from enrollment. Post-transplant cyclophosphamide (PTCy) was used in 23.9%, 83.9%, 65.2% and 0% of MUD, HAPLO, MMUD and UCB HCT. In multivariate analysis, compared to MUD, survival after HCT was significantly lower for patients receiving UCB (HR 2.65, p< 0.001) but not statistically different for HAPLO and MMUD HCT recipients (HR 1.08 and 1.18). The risk of relapse was not significantly different by donor type, but treatment-related mortality (TRM) (HR 3.31, p< 0.001) and disease-free survival (DFS) (HR 1.99, p=0.002) were inferior for UCB but not different for HAPLO and MMUD than MUD. In PTCy patients, HAPLO and MMUD were associated with increased grade 3/4 acute GVHD (HR 2.39, p=0.017 and 2.53, p=0.038) and chronic GVHD (HR 1.71 each, p=0.028 and 0.080) than MUD, but other outcomes were not different. HAPLO or MMUD may effectively be used to expedite transplantation when finding MUD is unlikely. NCT03904134.

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