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Haematologica. 2018 Aug;103(8):1317-1328. doi: 10.3324/haematol.2018.189258. Epub 2018 May 10.

Outcomes of hematopoietic stem cell transplantation from unmanipulated haploidentical versus matched sibling donor in patients with acute myeloid leukemia in first complete remission with intermediate or high-risk cytogenetics: a study from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation.

Author information

1
Service d'Hématologie et Thérapie Cellulaire Hôpital Saint Antoine, Paris, France.
2
Hematology Department, Federico II University, Naples, Italy.
3
Hospital Saint-Antoine, Paris University UPMC, France.
4
Acute Leukemia Working Party of EBMT, Paris, France.
5
Service d'Hématologie et Thérapie Cellulaire Hôpital Saint Antoine, Paris, France annalisaruggeri80@hotmail.com.
6
Department of Pediatric Hematology and Oncology, IRCCS Bambino Gesù Children's Hospital, Roma, Italy.
7
Shariati Hospital, Hematology-Oncology and BMT Research, Teheran, Iran.
8
Haematology and BMT Unit, IRCCS Ospedale San Raffaele, Milano, Italy.
9
Programme de Transplantation &Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, France.
10
Stem Cell Transplant Unit, Policlinico Universitario Tor Vergata, Rome, Italy.
11
Hopital St. Louis, Dept.of Hematology - BMT, Paris, France.
12
Hematology department, Institut Gustave Roussy, Villejuif, France.
13
Ospedale San Martino, Department of Haematology II Genova.
14
A.O.U. Città della Salute e della Scienza, Torino, Italy.
15
Institut Universitaire du Cancer Toulouse, Oncopole, France.
16
Unità Terapia Intensiva Ematologica per il Trapianto Emopoietico, Ospedale Civile, Pescara, Italia.
17
Hopital Jean Minjoz, Service d'Hématologie, Besançon, France.
18
Chaim Sheba Medical Center, Tel-Hashomer, Israel.

Abstract

Allogeneic hematopoietic stem cell transplantation is the optimal care for patients with high-risk or intermediate - acute myeloid leukemia. In patients lacking matched sibling donor, haploidentical donors are an option. We compared outcomes of unmanipulated (Haplo) to matched sibling donor transplant in acute myeloid leukemia patients in first complete remission. Included were intermediate and high-risk acute myeloid leukemia in first complete remission undergoing Haplo and matched sibling donor transplant from 2007-2015, and reported to the ALWP of the EBMT. A propensity score technique was used to confirm results of main analysis: 2 matched sibling donors were matched with 1 Haplo. We identified 2654 pts (Haplo =185; matched sibling donor =2469), 2010 with intermediate acute myeloid leukemia (Haplo=122; matched sibling donor =1888) and 644 with high-risk acute myeloid leukemia (Haplo =63; matched sibling donor =581). Median follow up was 30 (range 1-116) months. In multivariate analysis, in intermediate - acute myeloid leukemia patients, Haplo resulted in lower leukemia-free survival (Hazard Ratio 1.74; P<0.01), overall-survival (HR 1.80; P<0.01) and GvHD-free-relapse-free survival (Hazard Ratio 1.32; P<0.05) and higher graft-versus-host disease (GvHD) non-relapse mortality (Hazard Ratio 3.03; P<0.01) as compared to matched sibling donor. In high-risk acute myeloid leukemia, no differences were found in leukemia-free survival, overall-survival, and GvHD-free- relapse-free survival according to donor type. Higher grade II-IV acute GvHD was observed for Haplo in both high-risk (Hazard Ratio 2.20; P<0.01) and intermediate risk (Hazard Ratio 1.84; P<0.01). A trend for a lower Relapse-Incidence was observed in Haplo among high-risk acute myeloid leukemia (Hazard Ratio 0.56; P=0.06). The propensity score analysis confirmed results. Our results underline that matched sibling donor is the first choice for acute myeloid leukemia patients in first complete remission. On the other hand, results of Haplo transplants are similar to matched sibling donor transplants in acute myeloid leukemia patients with high risk cytogenetics.

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