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

Nicole Santoro, M Labopin, Federica Giannotti, G Ehninger, D Niederwieser, A Brecht, M Stelljes, N Kröger, H Einsele, M Eder, M Hallek, B Glass, J Finke, F Ciceri, M Mohty, Annalisa Ruggeri, A Nagler

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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. © 2018 The Author(s).
Original languageEnglish
Article number55
JournalJournal of Hematology and Oncology
Volume11
Issue number1
DOIs
Publication statusPublished - 2018

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Santoro, N., Labopin, M., Giannotti, F., Ehninger, G., Niederwieser, D., Brecht, A., Stelljes, M., Kröger, N., Einsele, H., Eder, M., Hallek, M., Glass, B., Finke, J., Ciceri, F., Mohty, M., Ruggeri, A., & Nagler, A. (2018). 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. Journal of Hematology and Oncology, 11(1), [55]. https://doi.org/10.1186/s13045-018-0598-0