Post-transplant cyclophosphamide in one-antigen mismatched unrelated donor transplantation versus haploidentical transplantation in acute myeloid leukemia: a study from the Acute Leukemia Working Party of the EBMT

Giorgia Battipaglia*, Jacques-Emmanuel Galimard, Myriam Labopin, Anna Maria Raiola, Didier Blaise, Annalisa Ruggeri, Yener Koc, Zafer Gülbas, Antonin Vitek, Simona Sica, Jose Luiz Diez-Martin, Luca Castagna, Benedetto Bruno, Montserrat Rovira, Ivan Moiseev, Massimo Martino, Giovanni Grillo, Mercedes Colorado Araujo, Claude Eric Bulabois, Stéphanie NguyenGerard Socié, Mutlu Arat, Jiri Pavlu, Johanna Tischer, Hans Martin, Lucia Lopez Corral, Goda Choi, Edouard Forcade, Andrew McDonald, Fabrizio Pane, Ali Bazarbachi, Fabio Ciceri, Arnon Nagler, Mohamad Mohty

*Corresponding author for this work

    Research output: Contribution to journalArticleAcademicpeer-review

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    Abstract

    Whether to choose Haploidentical (Haplo) or one-antigen mismatched unrelated donor (1Ag-MMUD) hematopoietic cell transplantation (HCT) with post-transplant cyclophosphamide (PTCy) remains an unanswered question. We compared PTCy- Haplo-HCT to PTCy-1Ag-MMUD-HCT for acute myeloid leukemia (AML) in complete remission (three groups: 1Ag-MMUD using peripheral blood (1Ag-MMUD-PB; n = 155); Haplo using bone marrow (Haplo-BM; n = 647) or peripheral blood (Haplo-PB; n = 949)). Haplo-BM and Haplo-PB had a higher non-relapse mortality (NRM) compared to 1Ag-MMUD-PB (HR 2.28, 95% CI 1.23-4.24, p < 0.01; HR 2.65, 95% CI 1.46-4.81, p < 0.01, respectively). Haplo groups experienced a lower leukemia-free survival (LFS) compared to 1Ag-MMUD-PB (Haplo-BM: HR 1.51, 95% CI 1.06-2.14, p = 0.02; Haplo-PB: 1.47, 95% CI 1.05-2.05, p = 0.02); overall survival (OS) was also lower in Haplo-HCT (Haplo-BM: HR 1.50, 95% CI 1.02-2.21, p = 0.04; Haplo-PB: HR 1.51, 95% CI 1.05-2.19, p = 0.03). No differences were observed for graft-versus-host/relapse-free survival (GRFS) and relapse incidence (RI). Haplo-BM was associated with a lower risk of grade III-IV acute graft-versus-host disease (GVHD) (HR 0.44, 95% CI 0.24-0.81; p < 0.01), while no statistical differences were observed between groups for grade II-IV aGVHD and for cGVHD. Use of PTCy in 1Ag-MMUD-HCT is a valid alternative to consider when using alternative donors. Larger analysis of 1Ag-MMUD versus Haplo-HCT are warranted.

    Original languageEnglish
    Pages (from-to)562-571
    Number of pages10
    JournalBone marrow transplantation
    Volume57
    Issue number4
    DOIs
    Publication statusPublished - Apr-2022

    Keywords

    • Cyclophosphamide/pharmacology
    • Graft vs Host Disease
    • Hematopoietic Stem Cell Transplantation
    • Humans
    • Leukemia, Myeloid, Acute/therapy
    • Retrospective Studies
    • Transplantation Conditioning
    • Transplantation, Haploidentical
    • Unrelated Donors

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