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Outcomes of haploidentical vs matched sibling transplantation for acute myeloid leukemia in first complete remission.


ABSTRACT: HLA-haploidentical hematopoietic cell transplantation (Haplo-HCT) using posttransplantation cyclophosphamide (PT-Cy) has improved donor availability. However, a matched sibling donor (MSD) is still considered the optimal donor. Using the Center for International Blood and Marrow Transplant Research database, we compared outcomes after Haplo-HCT vs MSD in patients with acute myeloid leukemia (AML) in first complete remission (CR1). Data from 1205 adult CR1 AML patients (2008-2015) were analyzed. A total of 336 patients underwent PT-Cy-based Haplo-HCT and 869 underwent MSD using calcineurin inhibitor-based graft-versus-host disease (GVHD) prophylaxis. The Haplo-HCT group included more reduced-intensity conditioning (65% vs 30%) and bone marrow grafts (62% vs 7%), consistent with current practice. In multivariable analysis, Haplo-HCT and MSD groups were not different with regard to overall survival (P = .15), leukemia-free survival (P = .50), nonrelapse mortality (P = .16), relapse (P = .90), or grade II-IV acute GVHD (P = .98). However, the Haplo-HCT group had a significantly lower rate of chronic GVHD (hazard ratio, 0.38; 95% confidence interval, 0.30-0.48; P < .001). Results of subgroup analyses by conditioning intensity and graft source suggested that the reduced incidence of chronic GVHD in Haplo-HCT is not limited to a specific graft source or conditioning intensity. Center effect and minimal residual disease-donor type interaction were not predictors of outcome. Our results indicate a lower rate of chronic GVHD after PT-Cy-based Haplo-HCT vs MSD using calcineurin inhibitor-based GVHD prophylaxis, but similar other outcomes, in patients with AML in CR1. Haplo-HCT is a viable alternative to MSD in these patients.

SUBMITTER: Rashidi A 

PROVIDER: S-EPMC6595262 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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Outcomes of haploidentical vs matched sibling transplantation for acute myeloid leukemia in first complete remission.

Rashidi Armin A   Hamadani Mehdi M   Zhang Mei-Jie MJ   Wang Hai-Lin HL   Abdel-Azim Hisham H   Aljurf Mahmoud M   Assal Amer A   Bajel Ashish A   Bashey Asad A   Battiwalla Minoo M   Beitinjaneh Amer M AM   Bejanyan Nelli N   Bhatt Vijaya Raj VR   Bolaños-Meade Javier J   Byrne Michael M   Cahn Jean-Yves JY   Cairo Mitchell M   Ciurea Stefan S   Copelan Edward E   Cutler Corey C   Daly Andrew A   Diaz Miguel-Angel MA   Farhadfar Nosha N   Gale Robert P RP   Ganguly Siddhartha S   Grunwald Michael R MR   Hahn Theresa T   Hashmi Shahrukh S   Hildebrandt Gerhard C GC   Holland H Kent HK   Hossain Nasheed N   Kanakry Christopher G CG   Kharfan-Dabaja Mohamed A MA   Khera Nandita N   Koc Yener Y   Lazarus Hillard M HM   Lee Jong-Wook JW   Maertens Johan J   Martino Rodrigo R   McGuirk Joseph J   Munker Reinhold R   Murthy Hemant S HS   Nakamura Ryotaro R   Nathan Sunita S   Nishihori Taiga T   Palmisiano Neil N   Patel Sagar S   Pidala Joseph J   Olin Rebecca R   Olsson Richard F RF   Oran Betul B   Ringden Olov O   Rizzieri David D   Rowe Jacob J   Savoie Mary Lynn ML   Schultz Kirk R KR   Seo Sachiko S   Shaffer Brian C BC   Singh Anurag A   Solh Melhem M   Stockerl-Goldstein Keith K   Verdonck Leo F LF   Wagner John J   Waller Edmund K EK   De Lima Marcos M   Sandmaier Brenda M BM   Litzow Mark M   Weisdorf Dan D   Romee Rizwan R   Saber Wael W  

Blood advances 20190601 12


HLA-haploidentical hematopoietic cell transplantation (Haplo-HCT) using posttransplantation cyclophosphamide (PT-Cy) has improved donor availability. However, a matched sibling donor (MSD) is still considered the optimal donor. Using the Center for International Blood and Marrow Transplant Research database, we compared outcomes after Haplo-HCT vs MSD in patients with acute myeloid leukemia (AML) in first complete remission (CR1). Data from 1205 adult CR1 AML patients (2008-2015) were analyzed.  ...[more]

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