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Bone Marrow Transplant. 2019 Feb 4. doi: 10.1038/s41409-019-0459-7. [Epub ahead of print]

Unmanipulated haploidentical versus HLA-matched sibling allogeneic hematopoietic stem cell transplantation in relapsed/refractory acute myeloid leukemia: a retrospective study on behalf of the ALWP of the EBMT.

Author information

1
Hematology Department, Hôpital Saint Antoine, Service d'Hématologie et Thérapie Cellulaire, Paris, France. giorgia.battipaglia@aphp.fr.
2
Hematology Department, Federico II University, Naples, Italy. giorgia.battipaglia@aphp.fr.
3
Acute Leukemia Working Party of EBMT, Paris, France.
4
Hematology Department, Hôpital Saint Antoine, Service d'Hématologie et Thérapie Cellulaire, Paris, France.
5
Hospital Saint-Antoine, Paris University UPMC, INSERM U938, Paris, France.
6
Hematology and BMT Unit, IRCCS Ospedale San Raffaele; University Vita-Salute San, Raffaele, Milano, Italy.
7
Department of Internal Medicine III, University Hospital of Munich-Grosshadern, Ludwig-Maximilians University, Munich, Germany.
8
Department of Medicine / Hematology and Oncology, University of Muenster, Muenster, Germany.
9
Universitaetsklinikum Dresden, Medizinische Klinik und Poliklinik I, Dresden, Germany.
10
Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital of Essen, Essen, Germany.
11
University of Freiburg, Dept. of Medicine -Hematology, Oncology, Freiburg, Germany.
12
Ospedale San Martino, Department of Haematology II Genova, Genova, Italy.
13
Hannover Medical School, Department of Haematology, Hemostasis, Oncologyand Stem Cell Transplantation, Hannover, Germany.
14
First State Pavlov Medical University of St. Petersburg, Lev Tolstoy St Petersburg, Russia.
15
Azienda Ospedaliero Universitaria di Udine, Division of Hematology, Udine, Italy.
16
Department of Pediatric Hematology and Oncology, IRCCS Bambino Gesù Children's Hospital, Roma, Italy.
17
Chaim Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel.

Abstract

Refractory or relapsed acute myeloid leukemia (R/R-AML) has poor prognosis. Allogeneic hematopoietic stem-cell transplantation (HSCT) may provide cure in this scenario. We compared outcomes of HSCT from HLA-identical (HLA-id, n = 1654) sibling or haploidentical (Haplo, n = 389) donors in patients with R/R-AML, performed during the period 2007-2015. The Haplo group included patients receiving an unmanipulated graft (post-transplant cyclophosphamide, n = 278; in vivo T-cell depletion, n = 95; or both, n = 16). Median age at HSCT was 52 (range 18-74) years. Median follow-up was 16 and 22 months for HLA-id sibling and Haplo recipients, respectively (p = 0.11). Compared to MSD, Haplo HSCT were performed more recently (2013 vs 2011, p < 0.01), at longer interval from diagnosis (7 vs 5 months, p < 0.01), more frequently using bone marrow as stem cell source (47% vs 8%, p < 0.01) and with a reduced intensity conditioning regimen (50% vs 43%, p = 0.03). Engraftment was higher (93% vs 83%, p < 0.01) in HLA-id sibling. In multivariate analysis, Haplo HSCT was associated with lower GVHD/relapse-free survival, inferior LFS and OS and higher NRM, mainly due to a higher rate of infections (41% vs 25%, p < 0.01). For R/R-AML, HLA-id sibling donors remain the gold standard, when available, due to higher mortality in Haplo without significant gain in disease control.

PMID:
30718798
DOI:
10.1038/s41409-019-0459-7

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