Description of Research Expertise
Allogeneic blood or marrow transplantation is the only potentially curative option for patients with relapsed, refractory, or high-risk hematologic malignancies. Unfortunately, only a third of patients have an available HLA-matched related donor. Partially HLA-mismatched related (HLA-haploidentical) transplantation allows identification of a donor for the vast majority of patients. In the past, HLA-haploidentical transplantation was associated with excessive nonrelapse mortality and poor overall survival. My research has contributed to the understanding of a novel technique that utilizes post-transplant cyclophosphamide as graft-versus-host disease prophylaxis after HLA-haploidentical transplantation. Using risk stratification with the disease risk index developed by Armand et al., I demonstrated that outcomes after nonmyeloablative HLA-haploidentical transplantation are comparable to that after reduced intensity HLA-matched transplantation. Similar to my work in older patients described above, I have also shown that nonmyeloablative HLA-haploidentical transplantation is safe and effective for pediatric and young adult patients. In addition, I have contributed to research examining early biomarkers, such as ST2, as predictors of nonrelapse mortality after HLA-haploidentical transplantation. Finally, to improve outcomes further, I have conducted research to examine the association of donor characteristics with transplantation outcomes. I showed that parent donors were associated with more graft failure when compared with sibling or offspring donors, but that survival was no different. Importantly, in that analysis, survival was affected by recipient age with recipients over 55 having inferior survival to younger patients. This work supports my proposed research agenda to evaluate the utility of the frailty phenotype tools to predict an older patient’s risk of nonrelapse mortality after induction chemotherapy and allogeneic transplantation as discussed in this proposal. Finally, my research has contributed to the widespread adoption of HLA-haploidentical transplantation with post-transplant cyclophosphamide, I have advanced the understanding of how we can improve its outcomes further, and I hope to continue to advance the field through studying frailty phenotype assessments in older patients with leukemia and myeloid malignancies undergoing induction then consolidative allogeneic transplantation.