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Am J Hematol. 2018 Jun;93(6):769-777. doi: 10.1002/ajh.25087. Epub 2018 Apr 11.

Haploidentical transplantation outcomes for secondary acute myeloid leukemia: Acute Leukemia Working Party (ALWP) of the European Society for Blood and Marrow Transplantation (EBMT) study.

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Vanderbilt University Medical Center, Nashville, Tennessee.
EBMT Paris study office/CEREST-TC, Department of Haematology, Saint Antoine Hospital, INSERM UMR 938, Université Pierre et Marie Curie, Paris, France.
Ospedale San Raffaele s.r.l., Milano, Italy.
Programme de Transplantation and Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France.
Department of Medicine III, University Hospital, LMU Munich, Germany.
Universitaetsklinikum Dresden, Medizinische Klinik und Poliklinik I, Dresden, Germany.
Department of Haematology II, Ospedale San Martino, Genova, Italy.
Medical Park Hospitals, Stem Cell Transplant Unit, Antalya, Turkey.
Ospedale Civile, Dipartimento di Ematologia, Medicina Trasfusionale e Biotecnologie, Pescara, Italy.
CHU Bordeaux, Hôpital Haut-leveque, Pessac, France.
Istituto Clinico Humanitas, Transplantation Unit, Department of Oncology and Haematology, Milano, Italy.
Hôpital Saint-Antoine, Universite Pierre & Marie Curie and INSERM, Centre de Recherche Saint-Antoine, UMRs U938, Paris, France.
Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel and the ALWP office of the EBMT Hôpital Saint-Antoine, Paris, France.


Secondary acute myeloid leukemia (sAML) traditionally has inferior outcomes compared to de novo AML. Allogeneic hematopoietic cell transplantation (HCT) is the sole potentially curative therapy. This study analyzes the outcomes for unmanipulated haploidentical HCT (haploHCT) for sAML using the Acute Leukemia Working Party (ALWP) registry of the European Society for Blood and Marrow Transplantation (EBMT). We identified 154 patients with sAML who underwent haploHCT from 2006 to 2016. Median age at HCT was 60 years with time from diagnosis to HCT 5 months. At transplantation, 69 patients were in first CR and 85 had active disease. Fifty-seven (38.0%) patients underwent myeloablative conditioning and 97 (62.0%) reduced intensity conditioning (RIC) conditioning. Multivariate analysis showed that there was no difference in RI, nonrelapse mortality (NRM), leukemia free survival (LFS), overall survival (OS), or GVHD-free/relapse free survival (GRFS) for conditioning intensity, age, performance status, or graft source. Active disease was associated with higher RI and inferior LFS, OS, and GRFS compared with patients in CR at time of transplant. T-cell depletion with anti-thymoglobulin resulted in higher NRM and inferior LFS, OS, and GRFS compared to post-transplant cyclophosphamide (PTCy) (HR 2.25, 2.01, 2.16, and 1.73, respectively with P values <.05). Our data shows that haploHCT is a feasible alternative for sAML when matched transplantation is unavailable.

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