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Acute Myeloid Leukemia
Alternative donor transplantation for acute myeloid leukemia in patients aged ≥50 years: young HLA-matched unrelated or haploidentical donor?
Miguel-Angel Perales,1* Benjamin Tomlinson,2* Mei-Jie Zhang,3,4
Andrew St. Martin,3 Amer Beitinjaneh,5 John Gibson,6 William Hogan,7 Natasha Kekre,8 Hillard Lazarus,2 David Marks,9 Joseph McGuirk,10 Rizwan Romee,11 Melhem Solh,12 John E. Wagner,13 Daniel J. Weisdorf,14 Marcos de Lima2 and Mary Eapen3
*MAP and BT share first authorship
1Adult Bone Marrow Transplant Services, Department of Medicine, Memorial Sloan- Kettering Cancer Center, and Department of Medicine, Weill Cornell Medical College, New York, NY, USA; 2Seidman Cancer Center, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA; 3Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA; 4Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA; 5UM Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA; 6Institute of Haematology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; 7Bone Marrow Transplant Program, Mayo Clinic, Rochester, MN, USA; 8Blood and Marrow Transplant Program, The Ottawa Hospital, Ottawa, ON, Canada; 9University Hospitals Bristol National Health Service Foundation Trust, Bristol, UK; 10Division of Hematologic Malignancies and Cellular Therapy, University of Kansas Medical Center, Kansas City, KS, USA; 11Division of Hematologic Malignancies and Transplantation, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA; 12The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA; 13BMT Program, University of Minnesota Masonic Children’s Hospital, Minneapolis, MN, USA and 14University of Minnesota Medical Center, Minneapolis, MN, USA
ABSTRACT
We sought to study whether survival after haploidentical transplan- tation is comparable to that after matched unrelated donor trans- plantation for 822 patients aged 50-75 years with acute myeloid leukemia in first or second complete remission. One hundred and ninety- two patients received grafts from haploidentical donors (sibling 25%; off- spring 75%) and 631 patients from matched unrelated donors aged 18-40 years. Patients' and disease characteristics of the two groups were similar except that recipients of matched unrelated donor transplantation were more likely to have poor risk cytogenetics and more likely to receive mye- loablative conditioning regimens. Time from documented remission to transplant did not differ by donor type. Five-year overall survival was 32% and 42% after haploidentical and matched unrelated donor transplant, respectively (P=0.04). Multivariable analysis showed higher mortality (haz- ard ratio 1.27, P=0.04) and relapse (hazard ratio 1.32, P=0.04) after hap- loidentical transplantation, with similar non-relapse mortality risks. Chronic graft-versus-host disease was higher after matched unrelated donor compared to haploidentical transplantation when bone marrow was the graft (hazard ratio 3.12, P<0.001), but when the graft was peripheral blood, there was no difference in the risk of chronic graft-versus-host disease between donor types. These data support the view that matched unrelated donor transplant with donors younger than 40 years is to be preferred.
Introduction
Standard post-remission therapy for eligible patients with high risk or relapsed acute myeloid leukemia (AML), including older patients, is an allogeneic
Ferrata Storti Foundation
Haematologica 2018 Volume 105(2):407-413
Correspondence:
MARY EAPEN
meapen@mcw.edu
Received: December 21, 2018. Accepted: May 16, 2019. Pre-published: May 17, 2019.
doi:10.3324/haematol.2018.215202
Check the online version for the most updated information on this article, online supplements, and information on authorship & disclosures: www.haematologica.org/content/105/2/407
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