Encouraging Outcomes of Haploidentical Hematopoietic Stem Cell Transplantation - Single Centre Experience from Resource Poor Country

High cost of matched unrelated donor stem cells limits its use in resource poor countries. Haploidentical donor is readily available for most of patients and at much lower cost, so can be feasible for poor patients. Here, we are reporting the outcome of 19 patients (16 male, 3 female), median age 37 years(15-63 yrs), who underwent Haplo HSCT using peripheral blood stem cells(n=16) and marrow (n=3) during October 2011 to September 2014 at Rajiv Gandhi Cancer Institute & Research Centre (India) using non myeloablative (NMA) and reduced intensity conditioning regimen (RIC) for haematological disorders (AA=2,ALL=4,AML=5,NHL=1,HL=2, MM=1,CML=5) with post transplant cyclophosphamide for GvHD prophylaxis. Fourteen patients were in remission at the time of transplant. Seven patients recieved RIC with BuFluCy(n=5) and BuFlu(n=2), 12 patients recieved NMA conditioning with FluCyATG(n=3) and FluCyTBI(n=9). Median CD34 cell dose was 5 X10⁶cells/kg. Fifteen patients (79%) were engrafted, with a median time to neutrophil engraftment of 15 days (range, 9-22) & platelet engraftment of 14 days (range, 10-46). Nine patients had documented bacterial infection in first 100 days whereas none had documented fungal infection. Primary and secondary CMV reactivation occurred 7 (36.8%) and 2 (10.5%) patients. The estimated day 100 and 1 year overall survival (OS) was 84.2±0.84% & 52.1±0.127 % respectively.  The estimated 1 year event free survival (EFS) & non relapse mortality (NRM) was 48.4±0.123% & 26.3%. Cumulative incidence of aGVHD (II-IV) and (III-IV) was 26.3% & 5.2% whereas cumulative incidence of chronic GVHD at 1 year & 2 year was 15.8% & 10.5% respectively. Graft rejection was seen in 6 patients (31.5%, 5 primary and 1 secondary). These results suggest that this approach is safe & effective, with rapid multilineage engraftment, low rates of both aGVHD & cGVHD and low NRM.