Stem cell transplantation from a haploidentical donor versus a genoidentical sister for adult male patients with acute myelogenous leukemia in first remission: A retrospective study from the acute leukemia working party of the European Society for Blood and Marrow Transplantation

Norbert Claude Gorin, Myriam Labopin, Didier Blaise, Marco de Groot, Gerard Socié, Jean Henri Bourhis, Fabio Ciceri, Emmanuelle Polge, Arnon Nagler, Mohamad Mohty

Research output: Contribution to journalArticlepeer-review

Abstract

Background: In adult patients with acute myeloid leukemia (AML), a matched sibling donor (MSD) is considered the first choice for an allogeneic transplantation. However, a female donor for a male recipient is a poor prognostic factor. The authors compared haploidentical (HAPLO) donors with female MSDs. Methods: In total, 834 men underwent allogenic transplantation from a female MSD, and 232 men underwent allogenic transplantation from a HAPLO donor. Of these, 86% of HAPLO recipients and 3% of MSD recipients received graft-versus-host disease (GVHD) prophylaxis posttransplantation with high-dose cyclophosphamide. A significant qualitative interaction was observed between donor type and cytogenetics, Therefore, the analyses were stratified on cytogenetics. Results: Of the men with intermediate-risk AML, 638 received transplantation from a female MSD, and 160 received transplantation from a HAPLO donor. In multivariate analysis, poor risk factors were a HAPLO donor versus an MSD for nonrelapse mortality (hazard ratio [HR], 1.7; P =.02) and patient age for nonrelapse mortality and overall survival (HR, 1.22 [P =.02] and 1.15 [P =.02], respectively). HAPLO transplantation resulted in less chronic GVHD (HR, 0.43; P < 10−4) but lower leukemia-free survival (HR, 1.7; P =.04). The GVHD/relapse-free survival (GRFS) was not different. Of the men with high-risk AML, 196 received transplantation from a female MSD, and 72 received transplantation from a HAPLO donor. By multivariate analysis, HAPLO recipients had a lower incidence of relapse (HR, 0.40; P =.004), better leukemia-free survival (HR, 0.46; P =.003), better overall survival (HR, 0.43; P =.003), and better GRFS (HR, 0.54; P =.006). Conclusions: In men who have intermediate-risk AML, allogenic transplantation from a sister MSD or a HAPLO donor produces similar GRFS. However, in men who have high-risk AML, a HAPLO donor combined with prophylactic high-dose cyclophosphamide posttransplantation may be a better choice.

Original languageEnglish
Pages (from-to)1004-1015
Number of pages12
JournalCancer
Volume126
Issue number5
DOIs
StatePublished - 1 Mar 2020
Externally publishedYes

Keywords

  • acute myeloid leukemia
  • haploidentical donors
  • matched sibling donors
  • stem cell transplantation

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