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Leukemia. 2019 Aug 19. doi: 10.1038/s41375-019-0544-3. [Epub ahead of print]

Haploidentical vs. unrelated allogeneic stem cell transplantation for acute lymphoblastic leukemia in first complete remission: on behalf of the ALWP of the EBMT.

Author information

1
Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel. noga.shemtov@sheba.health.gov.il.
2
Department of Hematology, EBMT Paris Study Office/CEREST-TC, Saint Antoine Hospital, Paris, France.
3
HUCH Comprehensive Cancer Center, Stem Cell Transplantation Unit, Helsinki, Finland.
4
Programme de Transplantation & Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille Institut Paoli Calmettes, Marseille, France.
5
Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Lyon, France.
6
Hospital St. Louis, Department of Hematology-BMT, Paris, France.
7
University Hospital Eppendorf, Bone Marrow Transplantation Centre, Hamburg, Germany.
8
Karolinska University Hospital, Department of Hematology, Stockholm, Sweden.
9
First State Pavlov Medical University of St. Petersburg, Raisa Gorbacheva Memorial Research Institute for Paediatric Oncology, Hematology, and Transplantation, St. Petersburg, Russia.
10
CHU Nantes, Département D'Hematologie, Nantes, France.
11
Klinikum Grosshadern, Med. Klinik III, Munich, Germany.
12
Silesian Medical Academy, University Department of Haematology and BMT, Katowice, Poland.
13
Charles University Hospital, Department of Hematology/Oncology, Pilsen, Czech Republic.
14
University of Zagreb, School of Medicine, Department of Internal Medicine, Zagreb, Croatia.
15
Department of Bone Marrow Transplantation and Oncohematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland.
16
Saint Antoine Hospital, Paris, France.
17
Department of Haematology, EBMT Paris study Office/CEREST-TC and Université Pierre et Marie Curie, Paris, France.
18
Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel.
19
Acute Leukemia Working Party of the EBMT, Paris, France.

Abstract

Unmanipulated haploidentical allogeneic stem cell transplantation (Allo-SCT) has become an attractive alternative for patients lacking HLA-matched sibling or unrelated donors. However, data of outcome in ALL is still scarce. The outcomes of 1234 adult patients with ALL in first complete remission (CR1) who underwent Allo-SCT between 2007 and 2016 were analyzed. Comparison was done between haploidentical donor (Haplo) (136 patients), matched unrelated donor (MUD 10/10) (809 patients), and mismatched unrelated donor (MMUD 9/10) (289 patients). Univariate analysis showed similar outcomes in Haplo, MUD, and MMUD, including OS, LFS, RI, NRM, AGVHD, and CGVHD. In multivariate analysis, Haplo was not associated with worse outcomes compared to MUD 10/10 and MMUD 9/10. Indeed, compared to Haplo, the hazard ratio (HR) for LFS, OS, RI, NRM, AGVHD, and CGVHD were 1.1 (p = 0.7), 0.9 (p = 0.4), 1.35 (p = 0.2), 0.7 (p = 0.2), 1.1 (p = 0.8), and 0.8 (p = 0.2) for MUD, respectively, and 1.1 (p = 0.8), 1.0 (p = 1.0), 1.2 (p = 0.3), 0.8 (p = 0.4), 1.2 (p = 0.3), and 0.9 (p = 0.6) for MMUD, respectively. In conclusion, outcomes of adult patients with ALL in CR1 receiving Haplo Allo-SCT are comparable to MUD or MMUD transplants. Haplo should be considered as a clinically relevant option for patients lacking a matched sibling donor.

PMID:
31427719
DOI:
10.1038/s41375-019-0544-3

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