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Biol Blood Marrow Transplant. 2020 Jan 9. pii: S1083-8791(20)30013-6. doi: 10.1016/j.bbmt.2020.01.003. [Epub ahead of print]

Haploidentical Transplantation with Post-Transplantation Cyclophosphamide for T Cell Acute Lymphoblastic Leukemia: A Report from the European Society for Blood and Marrow Transplantation Acute Leukemia Working Party.

Author information

1
Bone Marrow Transplant Program, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon. Electronic address: bazarbac@aub.edu.lb.
2
EBMT Paris Study Office/CEREST-TC, Hôpital Saint Antoine, Paris, France.
3
Hematology and Transplant Center, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
4
Bone Marrow Transplantation Department, Anadolu Medical Center Hospital, Kocaeli, Turkey.
5
Adult Bone Marrow Transplantation Center, Baskent University Adana Hospital, Adana, Turkey.
6
Hematopoietic SCT Unit, Florence Nightingale Sisli Hospital, Istanbul, Turkey.
7
Department of Hematology and BMT, Ospedale S. Camillo-Forlanini, Rome, Italy.
8
Onco-Hematology Division, European Institute of Oncology IRCCS, Milan, Italy.
9
Hematology Clinic of the University of Milano-Biocca, Ospedale San Gerardo, Monza, Italy.
10
Hospital Clinic, BMT Unit, Hematology Department, Institute of Hematology & Oncology. Institut d'Investigació Biomèdica August Pi I Sunyer, University of Barcelona, Institut Josep Carreras, Barcelona, Spain.
11
Grande Ospedale Metropolitano Bianchi-Melacrino Morelli, Centro Unico Regionale Trapianti Midollo Osseo, Reggio Calabria, Italy.
12
Hematology and BMT, Ospedale San Raffaele, Milan, Italy.
13
Medicana International, Istanbul, Turkey.
14
Department of Hematology-BM, Hopital St. Louis, Paris, France.
15
Transplant and Cellular Immunotherapy Program, Department of Hematology, CRCM, Aix Marseille University, CNRS, INSERM, Institut Paoli Calmettes, Marseille, France.
16
Department of Hematology, Reina Sofía University Hospital, Biomedical Research of Córdoba, University of Córdoba, Cordoba, Spain.
17
Hematology Division, Department of Oncology, Hôpitaux Universitaires de Genève and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
18
BMT Unit, SC Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
19
UOC Terapie Cellulari e Officina Trasfusionale, Azienda Ospedaliera Universitaria Senese, Policlinico S.Maria alle Scotte, Siena, Italy.
20
Transplantation Unit, Department of Oncology and Hematology, Istituto Clinico Humanitas, Milan, Italy.
21
Albert Alberts Stem Cell Transplantation Centre, Netcare Pretoria East Hospital, Pretoria, South Africa.
22
Hematology and Transplant Center, Pesaro Hospital, Pesaro, Italy.
23
Department of Hematology with University Transplantation, Universitaria Policlinico Bari, Bari, Italy.
24
Hematology Service, Institute of Hematology and Blood Transfusion, Prague, Czech Republic.
25
Hematology, ICANS-Hopitaux Universitaires Strasbourg, Strasbourg, France.
26
Raisa Gorbacheva Memorial Research Institute for Paediatric Oncology, Hematology, and Transplantation. First State Pavlov Medical University of St Petersburg, St Petersburg, Russia.
27
Department of Internal Medicine 5, University Hospital Erlangen, Erlangen, Germany.
28
Department of Hematology, Hospital General Universitario Gregorio Marañon, Instituto de investigación sanitaria Gregorio Marañon, Departament of Medicine, Universidad Complutense, Madrid, Spain.
29
Chaim Sheba Medical Center, Tel-Hashomer, Israel.
30
Department of Hematology-BMT, Hopital St Antoine, Paris, France.
31
Department of Bone Marrow Transplantation and Oncohematology, Maria Sklodowska-Curie Institute Oncology Centre, Gliwice Branch, Gliwice, Poland.

Abstract

Allogeneic hematopoietic cell transplantation (HCT) is recommended in high-risk patients with T cell acute lymphoblastic leukemia (T-ALL). For patients without an HLA-identical donor, haploidentical (haplo-) HCT is becoming the leading source of stem cell donation. However, data are scarce on predictive factors for outcome in that setting. We identified 122 adults (20% female; median age, 31 years; range, 18 to 68 years) with T-ALL who underwent haplo-HCT with post-transplantation cyclophosphamide (ptCy) between 2010 and 2017. The median duration of follow-up of living patients was 23 months. The 2-year incidences of relapse and nonrelapse mortality were 45% and 21%, respectively. The 2-year leukemia-free survival (LFS), overall survival (OS), and graft-versus-host disease, relapse-free survival (GRFS) were 34%, 42%, and 27%, respectively. The 2-year LFS and OS were highly influenced by disease status at transplantation, being 49% and 55%, respectively, for patients in first complete remission (CR1); 34% and 50%, respectively, for those in second CR (CR2); and 8% and 12%, respectively, for patients with active disease. On multivariate analysis, only disease status was found to affect LFS and OS. Transplantation in CR2 negatively affected LFS, whereas active disease at the time of haplo-HCT negatively affected LFS and OS. In conclusion, haplo-HCT with ptCy produced encouraging results in this challenging disease, particularly when performed in patients in CR. Despite the limitation of the small sample size, our results were not affected by the type of conditioning, calling into question the need for total body irradiation-based myeloablative conditioning in that setting.

KEYWORDS:

Conditioning; Haploidentical stem cell transplantation; T-ALL; Thiotepa; Total body irradiation

PMID:
31926364
DOI:
10.1016/j.bbmt.2020.01.003

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