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Biol Blood Marrow Transplant. 2018 Aug 30. pii: S1083-8791(18)30528-7. doi: 10.1016/j.bbmt.2018.08.026. [Epub ahead of print]

HLA-Mismatched Donors in Patients with Myelodysplastic Syndrome: An EBMT Registry Analysis.

Author information

1
Hôpital Saint Louis, APHP, Université Paris 7, INSERM 1131, France. Electronic address: marie.robin@aphp.fr.
2
Faculty of Medicine, Paris Descartes University, Paris, France, Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, AP-HP, Paris, France and Team METHODS, Epidemiology and Statistics Sorbonne Cité Research Centre UMR 1153, INSERM.
3
Dipartimento di Oncoematologia e Terapia Cellulare e Genica, IRCCS Ospedale Pediatrico Bambino Gesù, Roma, Italy.
4
CRCM, Institut Paoli Calmettes, Aix-Marseille University, Marseille, France.
5
Department of Stem Cell. Transplantation, University Hospital Eppendorf, Hamburg, Germany.
6
EBMT Data Office Leiden, Leiden, The Netherlands.
7
Hematology and Transplant Unit, Ospedale Policlinico San Martino, Genova, Italy.
8
Universitaetsklinikum Carl Gustav, TU Dresden, Dresden, Germany.
9
Department of Haematology, Kings College Hospital NHS Foundation Trust, London, United Kingdom.
10
CHRU de Lille, LIRIC, INSERM U995, Université de Lille, Lille, France.
11
Stem Cell Transplant Unit, Medical Park Hospitals, Antalya, Turkey.
12
Hematology and Hematopoietic Stem Cell Transplantation Unit, Ospedale San Raffaele, Milano, Italy.
13
Department of Hematology and Oncology, University of Freiburg, Freiburg, Germany.
14
Service d'hématologie, Centre Hospitalier Lyon Sud, Lyon, France.
15
Hematology, Hospital Regional de Málaga, Málaga, Spain.
16
Allogene und autologe Stammzelltransplantation, Klinikum Rechts der Isar der TUM, Munich, Germany.
17
Hematology-Oncology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy.
18
Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands.
19
Service d'hématologie, CHU Nantes, Nantes, France.
20
Hematology, Nottingham University, Nottingham, United Kingdom.
21
Hematology, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
22
Service d'hématologie, CHU Lapeyronie, Montpellier, France.
23
Eurocord International Registry, Hôpital Saint-Louis, Paris, France.
24
Hematology, Radboud University Medical Center, Nijmegen, the Netherlands.

Abstract

Recently, haploidentical transplantation (haplo) using post-transplant cyclophosphamide (PTCy) has been reported to give very encouraging results in patients with hematological malignancies. Patients who have no HLA-matched donor currently have the choice between a mismatched unrelated donor, an unrelated cord blood (CB) donor, and a haploidentical related donor. The aim of our study is to compare the outcome of patients with myelodysplastic syndrome (MDS) who have been transplanted from a haploidentical donor using PTCy, an HLA-mismatched unrelated donor (marrow or peripheral blood stem cells), or an unrelated mismatched CB donor. A total of 833 MDS patients from the European Group for Blood and Marrow Transplantation (EBMT) registry, transplanted between 2011 and 2016, were identified. The potential benefit of haplo was compared with mismatched unrelated and CB donors in an adjusted and weighted model taking into account potential confounders and other prognostic variables. Haplo was at lower risk of acute graft-versus-host disease (GVHD) than mismatched unrelated donor (P = .010) but at similar risk than CB. Progression-free survival was better after haplo (versus mismatched unrelated, P = .056; versus CB, P = .003) and overall survival tended to be superior after haplo (versus mismatched unrelated, P = .082; versus CB, P = .002). Nonrelapse mortality was not significantly different between haplo and mismatched unrelated donors. Relapse risk was not influenced by the type of donor. In conclusion, patients with MDS from the EBMT registry receiving hematopoietic stem cell transplantation from a haplo donor have significantly better outcome than those receiving hematopoietic stem cell transplantation from a CB donor and at least similar or better outcome than with a mismatched unrelated donor. Prospective studies comparing the type of donors will be needed to confirm this assumption.

KEYWORDS:

HLA-mismatched donor; Haploidentical transplant; MDS; Myelodysplastic syndrome

PMID:
30172776
DOI:
10.1016/j.bbmt.2018.08.026

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