HLA-Mismatched Donors in Patients with Myelodysplastic Syndrome: An EBMT Registry Analysis

Marie Robin, Raphaël Porcher, Annalisa Ruggeri, Didier Blaise, Christine Wolschke, Linda Koster, Emanuele Angelucci, Friedrich Stölzel, Victoria Potter, Ibrahim Yakoub-Agha, Yener Koc, Fabio Ciceri, Jürgen Finke, Hélène Labussière-Wallet, Maria Jesús Pascual Cascon, Mareike Verbeek, Alessandro Rambaldi, Jan J Cornelissen, Patrice Chevallier, Rohini RadiaArnon Nagler, Nathalie Fegueux, Eliane Gluckman, Theo de Witte, Nicolaus Kröger

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Abstract

Recently, haploidentical transplantation (haplo) using post-transplant cyclophosphamide (PTCy) has been reported to give very encouraging results in patients with hematological malignancies. Patients who have no HLA-matched donor currently have the choice between a mismatched unrelated donor, an unrelated cord blood (CB) donor, and a haploidentical related donor. The aim of our study is to compare the outcome of patients with myelodysplastic syndrome (MDS) who have been transplanted from a haploidentical donor using PTCy, an HLA-mismatched unrelated donor (marrow or peripheral blood stem cells), or an unrelated mismatched CB donor. A total of 833 MDS patients from the European Group for Blood and Marrow Transplantation (EBMT) registry, transplanted between 2011 and 2016, were identified. The potential benefit of haplo was compared with mismatched unrelated and CB donors in an adjusted and weighted model taking into account potential confounders and other prognostic variables. Haplo was at lower risk of acute graft-versus-host disease (GVHD) than mismatched unrelated donor (P = .010) but at similar risk than CB. Progression-free survival was better after haplo (versus mismatched unrelated, P = .056; versus CB, P = .003) and overall survival tended to be superior after haplo (versus mismatched unrelated, P = .082; versus CB, P = .002). Nonrelapse mortality was not significantly different between haplo and mismatched unrelated donors. Relapse risk was not influenced by the type of donor. In conclusion, patients with MDS from the EBMT registry receiving hematopoietic stem cell transplantation from a haplo donor have significantly better outcome than those receiving hematopoietic stem cell transplantation from a CB donor and at least similar or better outcome than with a mismatched unrelated donor. Prospective studies comparing the type of donors will be needed to confirm this assumption.

Original languageEnglish
JournalBiology of Blood and Marrow Transplantation
DOIs
Publication statusE-pub ahead of print - Aug 30 2018

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Robin, M., Porcher, R., Ruggeri, A., Blaise, D., Wolschke, C., Koster, L., Angelucci, E., Stölzel, F., Potter, V., Yakoub-Agha, I., Koc, Y., Ciceri, F., Finke, J., Labussière-Wallet, H., Cascon, M. J. P., Verbeek, M., Rambaldi, A., Cornelissen, J. J., Chevallier, P., ... Kröger, N. (2018). HLA-Mismatched Donors in Patients with Myelodysplastic Syndrome: An EBMT Registry Analysis. Biology of Blood and Marrow Transplantation. https://doi.org/10.1016/j.bbmt.2018.08.026