Comparison of HLA-mismatched unrelated donor transplantation with post-transplant cyclophosphamide versus HLA-haploidentical transplantation in patients with active acute myeloid leukemia.

Abstract

HLA-haploidentical allogeneic hematopoietic stem cell transplantation (Haplo-HCT) is frequently used as treatment for patients with active acute myeloid leukemia (AML). Here, we investigated whether 9/10 HLA-mismatched unrelated donor transplantation (MMUD-HCT) with post-transplant cyclophosphamide (PTCy) is an adequate alternative. Inclusion criteria in this retrospective registry study consisted of adult patients, first HCT with a Haplo donor or MMUD between 2010 and 2020 using PTCy as graft-versus-host disease (GVHD) prophylaxis, and primary refractory or relapsed disease. MMUD patients were pair-matched 1 to 2 with Haplo-recipients. A total of 73 MMUD patients met the inclusion criteria. Their data were compared to those of 146 Haplo patients in a matched-pair analysis. Median follow-up was 27 months in MMUD patients and 36 months in Haplo recipients. Two-year incidences of relapse and non-relapse mortality (NRM) were 40% and 18% in MMUD patients, respectively, versus 50% (P = 0.23) and 24% (P = 0.18) in Haplo recipients. Two-year leukemia-free survival (LFS) and overall survival (OS) was 42% and 46% in MMUD recipients, respectively, versus 26% (P = 0.1) and 28% (P = 0.061) in Haplo-patients. In conclusions, in AML patients with active disease at transplantation, MMUD-HCT results in at least comparable outcomes to Haplo-HCT when PTCy is applied.

• Authors: Frédéric Baron, Myriam Labopin, Johanna Tischer, Fabio Ciceri, Anna Maria Raiola, Didier Blaise, Simona Sica, Jan Vydra, Renato Fanin, Jose Luis Diez-Martin, Claude Eric Bulabois, Friedrich Stölzel, Alessandro Busca, Pavel Jindra, Yener Koc, Patrice Chevallier, Edouard Forcade, Wolf Rösler, Jakob Passweg, Alexander Kulagin, Angelo Michele Carella, Celestine Simand, Ali Bazarbachi, Pietro Pioltelli, Arnon Nagler, Mohamad Mohty
• Journal: Bone marrow transplantation (Bone Marrow Transplant) Vol. 57 Issue 11 Pg. 1657-1663 (11 2022) ISSN: 1476-5365 [Electronic] England
• PMID: 35978005 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2022. The Author(s), under exclusive licence to Springer Nature Limited.

Chemical References

• Cyclophosphamide

Topics

• Adult
• Humans
• Transplantation, Haploidentical (adverse effects)
• Unrelated Donors
• Transplantation Conditioning (methods)
• Graft vs Host Disease (etiology)
• Retrospective Studies
• Cyclophosphamide (therapeutic use)
• Hematopoietic Stem Cell Transplantation (methods)
• Leukemia, Myeloid, Acute (drug therapy)