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Bone Marrow Transplant. 2020 Mar 17. doi: 10.1038/s41409-020-0849-x. [Epub ahead of print]

Alternative donors provide comparable results to matched unrelated donors in patients with acute lymphoblastic leukemia undergoing allogeneic stem cell transplantation in second complete remission: a report from the EBMT Acute Leukemia Working Party.

Author information

1
Sorbonne University, service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, APHP, INSERM U938 centre de Recherche Saint-Antoine, Paris, France. Eolia.brissot@gmail.com.
2
Acute Leukemia Working Party office, Hôpital Saint Antoine, APHP, Paris, France. Eolia.brissot@gmail.com.
3
Sorbonne University, service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, APHP, INSERM U938 centre de Recherche Saint-Antoine, Paris, France.
4
Acute Leukemia Working Party office, Hôpital Saint Antoine, APHP, Paris, France.
5
Unit of Blood Disease and Stem Cell Transplantation, DPT of Medical and Experimental Sciences, Brescia University, ASST Spedali Civili di Brescia, Brescia, Italy.
6
Robert-Bosch-Krankenhaus, Abt. Hämatologie/Onkologie, Stuttgart, Germany.
7
Universitaets-Klinikum Augsburg, II Medizinische Klinik, Augsburg, Germany.
8
Department of Haematology, Asklepios Klinik St. Georg, Hamburg, Germany.
9
Tel Aviv Sourasky Medical Center, Blood and Bone Marrow Transplantation, Tel Aviv, Israel.
10
Gazi University Faculty of Medicine, Hematology, Ankara, Turkey.
11
University Hospital, Hematology, Basel, Switzerland.
12
Leiden University Hospital, BMT Centre Leiden, Leiden, The Netherlands.
13
Klinik fuer Innere Medizin III, Universtätklinikum, Ulm, Germany.
14
Department of Haematology, Imperial College, Hammersmith Hospital, London, UK.
15
Department of Bone Marrow Transplantation, Branch Gliwice, Comprehensive Cancer Center M. Sklodowska-Curie Memorial Institute, Gliwice, Poland.
16
Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.

Abstract

Relapse of acute lymphoblastic leukemia (ALL) remains a major therapeutic challenge. Despite the consensus for proceeding to allogeneic stem cell transplantation (HSCT) in relapsing patients with ALL who achieve second complete remission (CR2) with salvage therapy, most patients lack a suitable matched-related histocompatible donor. The present multicenter retrospective study compared, for ALL patients in CR2, the HSCT outcome from all four possible alternative hematopoietic stem cell sources, namely matched unrelated 10/10 (n = 281), mismatched unrelated 9/10 (n = 125), haploidentical (n = 105), and cord blood (n = 104) donors. The 2-year outcomes were not statistically different between the four donor sources with respect to overall survival (38.3-47.2%), leukemia-free survival (30.5-39.6%), relapse incidence (32.6-37.6%), nonrelapse mortality (27.5-34.6%), and graft-versus-host disease-free relapse survival (21.4-33.1%). Donor choices for ALL patients achieving CR2 post first relapse are broad, ensuring that most patient in need secures a graft. Therefore, in practice, the donor choice should depend on timely availability and policy center.

PMID:
32203261
DOI:
10.1038/s41409-020-0849-x

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