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Ferrata Storti Foundation
Haematologica 2019 Volume 104(3):524-532
Acute Myeloid Leukemia
Haploidentical versus unrelated allogeneic stem cell transplantation for relapsed/ refractory acute myeloid leukemia:
a report on 1578 patients from the Acute Leukemia Working Party of the EBMT
Eolia Brissot,1 Myriam Labopin,1,2 Gerhard Ehninger,3 Matthias Stelljes,4
Arne Brecht,5 Arnold Ganser,6 Johanna Tischer,7 Nicolaus Kröger,8 Boris
Afanasyev,9 Jürgen Finke,10 Ahmet Elmaagacli,11 Herman Einsele,12 Mohamad
1Service d’Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, APHP, Paris, France; 2Acute Leukemia Working Party office, Hôpital Saint Antoine, APHP, Paris, France; 3Universitaetsklinikum Dresden, Medizinische Klinik und Poliklinik I, Germany; 4University of Münster, Department of Medicine A / Hematology and Oncology, Germany; 5Deutsche Klinik für Diagnostik, KMT Zentrum, Wiesbaden, Germany; 6Hannover Medical School, Department of Haematology, Hemostasis, Oncology, and Stem Cell Transplantation, Germany; 7Klinikum Grosshadern, Med. Klinik III, Munich, Germany; 8University Hospital Eppendorf, Bone Marrow Transplantation Centre, Hamburg, Germany; 9First State Pavlov Medical University of St. Petersburg, Raisa Gorbacheva Memorial Research Institute for Pediatric Oncology, Hematology, and Transplantation, Russia; 10University of Freiburg, Faculty of Medicine and Department of Medicine -Hematology, Oncology and Stem Cell Transplantation, Germany; 11Asklepios Klinik St. Georg, Department of Hematology, Hamburg, Germany; 12Universitaetsklinikum Würzburg, Med. Klinik und Poliklinik II, Germany and 13Hematology Division, Chaim Sheba Medical Center and Tel Aviv University, Tel-Hashomer, Ramat-Gan, Israel
ABSTRACT
Primary refractory or relapsed acute myeloid leukemia is associated with a dismal prognosis. Allogeneic stem cell transplantation is the only therapeutic option that offers prolonged survival and cure in this setting. In the absence of a matched sibling donor, transplantation from unrelated 10/10 HLA allele-matched or 9/10 HLA allele-mismatched donors and haploidentical donors are potential alternatives. The current study aimed to compare the outcomes of acute myeloid leukemia patients with active disease who received allogeneic stem cell transplantation from a hap- loidentical donor with post-transplant cyclophosphamide (n=199) versus an unrelated 10/10-matched donor (n=1111) and versus an unrelated 9/10-mis- matched donor (n=383) between 2007 and 2014 and who were reported to the European Society for Blood and Marrow Transplantation registry. Propensity score weighted analysis was conducted in order to control for disease risk imbalances between the groups. The leukemia-free survival rates at 2 years of recipients of grafts from a haploidentical donor, an unre- lated 10/10-matched donor and an unrelated 9/10-mismatched donor were 22.8%, 28% and 22.2%, respectively (P=NS). In multivariate analysis, there were no significant differences in leukemia-free survival, overall survival, relapse incidence, non-relapse mortality, or graft-versus-host-disease-free relapse-free survival between the three groups. Two predictive factors were associated with a higher relapse incidence: transplantation during first or second relapse compared to primary refractory acute myeloid leukemia and poor cytogenetics. Allogeneic stem cell transplantation may rescue about 25% of acute myeloid leukemia patients with active disease. Importantly, the outcomes of transplants from haploidentical donors were comparable to those from 10/10-matched and 9/10-mismatched unrelated donors. Therefore, a haploidentical donor is a valid option for acute myeloid leukemia patients with active disease.
1,2 2,13 Mohty * and Arnon Nagler
*
* MM and AN contributed equally to this study and share senior authorship
Correspondence:
EOLIA BRISSOT
eolia.brissot@aphp.fr
Received: February 4, 2018. Accepted: October 19, 2018. Pre-published: October 25, 2018.
doi:10.3324/haematol.2017.187450
Check the online version for the most updated information on this article, online supplements, and information on authorship & disclosures: www.haematologica.org/content/104/3/524
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