TY - JOUR
T1 - Unmanipulated haploidentical in comparison with matched unrelated donor stem cell transplantation in patients 60 years and older with acute myeloid leukemia
T2 - A comparative study on behalf of the ALWP of the EBMT
AU - Santoro, Nicole
AU - Labopin, Myriam
AU - Giannotti, Federica
AU - Ehninger, Gerard
AU - Niederwieser, Dietger
AU - Brecht, Arne
AU - Stelljes, Matthias
AU - Kröger, Nicolaus
AU - Einsele, Herman
AU - Eder, Matthias
AU - Hallek, Michael
AU - Glass, Bertram
AU - Finke, Jürgen
AU - Ciceri, Fabio
AU - Mohty, Mohamad
AU - Ruggeri, Annalisa
AU - Nagler, Arnon
N1 - Publisher Copyright:
© 2018 The Author(s).
PY - 2018/4/16
Y1 - 2018/4/16
N2 - Background: Acute myeloid leukemia (AML) is both more common and with more biologically aggressive phenotype in the elderly. Allogenic stem cell transplantation (allo-SCT) is the best treatment option in fit patients. Either HLA-matched unrelated donor (MUD) or haploidentical (Haplo) donor are possible alternative for patients in need. Methods: We retrospectively compared non-T-cell-depleted Haplo (n = 250) to 10/10 MUD (n = 2589) in AML patients ≥ 60 years. Results: Median follow-up was 23 months. Disease status at transplant differs significantly between the two groups (p < 10-4). Reduced intensity conditioning (RIC) was administrated to 73 and 77% of Haplo and MUD, respectively (p = 0.23). Stem cell source was the bone marrow (BM) in 52% of the Haplo and 6% of MUD (p < 10-4). Anti-thymocyte globulin (ATG) was most frequently used in MUD (p < 10-4) while post-Tx cyclophosphamide (PT-Cy) was given in 62% of Haplo. Engraftment was achieved in 90% of the Haplo vs 97% of MUD (p < 10-4). In multivariate analysis, no significant difference was found between Haplo and MUD for acute (a)graft versus host disease (GVHD) grade II-IV, relapse incidence (RI), non-relapse mortality (NRM), leukemia free survival (LFS), graft-versus-host-free-relapse free survival (GRFS), and overall survival (OS). Extensive chronic (c)GVHD was significantly higher for MUD as compared to Haplo (HR 2, p = 0.01, 95% CI 1.17-3.47). A propensity score analysis confirmed the higher risk of extensive cGVHD for MUD without differences for other outcomes. Conclusions: Allo-SCT from both Haplo and MUD are valid option for AML patients ≥ 60 years of age with similar results. Transplantation from MUD was associated with higher extensive cGVHD. Our findings suggest that Haplo is a suitable and attractive graft source for patients≥ 60 with AML in need of allo-SCT.
AB - Background: Acute myeloid leukemia (AML) is both more common and with more biologically aggressive phenotype in the elderly. Allogenic stem cell transplantation (allo-SCT) is the best treatment option in fit patients. Either HLA-matched unrelated donor (MUD) or haploidentical (Haplo) donor are possible alternative for patients in need. Methods: We retrospectively compared non-T-cell-depleted Haplo (n = 250) to 10/10 MUD (n = 2589) in AML patients ≥ 60 years. Results: Median follow-up was 23 months. Disease status at transplant differs significantly between the two groups (p < 10-4). Reduced intensity conditioning (RIC) was administrated to 73 and 77% of Haplo and MUD, respectively (p = 0.23). Stem cell source was the bone marrow (BM) in 52% of the Haplo and 6% of MUD (p < 10-4). Anti-thymocyte globulin (ATG) was most frequently used in MUD (p < 10-4) while post-Tx cyclophosphamide (PT-Cy) was given in 62% of Haplo. Engraftment was achieved in 90% of the Haplo vs 97% of MUD (p < 10-4). In multivariate analysis, no significant difference was found between Haplo and MUD for acute (a)graft versus host disease (GVHD) grade II-IV, relapse incidence (RI), non-relapse mortality (NRM), leukemia free survival (LFS), graft-versus-host-free-relapse free survival (GRFS), and overall survival (OS). Extensive chronic (c)GVHD was significantly higher for MUD as compared to Haplo (HR 2, p = 0.01, 95% CI 1.17-3.47). A propensity score analysis confirmed the higher risk of extensive cGVHD for MUD without differences for other outcomes. Conclusions: Allo-SCT from both Haplo and MUD are valid option for AML patients ≥ 60 years of age with similar results. Transplantation from MUD was associated with higher extensive cGVHD. Our findings suggest that Haplo is a suitable and attractive graft source for patients≥ 60 with AML in need of allo-SCT.
KW - Acute myeloid leukemia
KW - Allogeneic stem cell transplantation
KW - Elderly
KW - Haploidentical
KW - MUD
UR - http://www.scopus.com/inward/record.url?scp=85045531034&partnerID=8YFLogxK
U2 - 10.1186/s13045-018-0598-0
DO - 10.1186/s13045-018-0598-0
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C2 - 29661208
AN - SCOPUS:85045531034
VL - 11
JO - Journal of Hematology and Oncology
JF - Journal of Hematology and Oncology
SN - 1756-8722
IS - 1
M1 - 55
ER -
