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Scientific article
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Unmanipulated haploidentical in comparison with matched unrelated donor stem cell transplantation in patients 60 years and older with acute myeloid leukemia: a comparative study on behalf of the ALWP of the EBMT

Published inJournal of hematology & oncology, vol. 11, no. 1, 55
Publication date2018-04-16
First online date2018-04-16
Abstract

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.

eng
Keywords
  • Acute myeloid leukemia
  • Allogeneic stem cell transplantation
  • Elderly
  • Haploidentical
  • MUD
  • Aged
  • Aged, 80 and over
  • Female
  • Hematopoietic Stem Cell Transplantation / methods
  • Humans
  • Leukemia, Myeloid, Acute / pathology
  • Leukemia, Myeloid, Acute / therapy
  • Male
  • Retrospective Studies
  • Transplantation Conditioning / methods
  • Unrelated Donors
Citation (ISO format)
SANTORO, Nicole et al. Unmanipulated haploidentical in comparison with matched unrelated donor stem cell transplantation in patients 60 years and older with acute myeloid leukemia: a comparative study on behalf of the ALWP of the EBMT. In: Journal of hematology & oncology, 2018, vol. 11, n° 1, p. 55. doi: 10.1186/s13045-018-0598-0
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ISSN of the journal1756-8722
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