Unmanipulated haploidentical versus HLA-matched sibling allogeneic hematopoietic stem cell transplantation in relapsed/refractory acute myeloid leukemia: a retrospective study on behalf of the ALWP of the EBMT

Giorgia Battipaglia, Ariane Boumendil, Myriam Labopin, Fabio Ciceri, Johanna Tischer, Matthias Stelljes, Gerhard Ehninger, Dietrich Beelen, Jürgen Finke, Maria Teresa Van Lint, Matthias Eder, Boris Afanasyev, Renato Fanin, Mohamad Mohty, Annalisa Ruggeri, Arnon Nagler

Research output: Contribution to journalArticle

Abstract

Refractory or relapsed acute myeloid leukemia (R/R-AML) has poor prognosis. Allogeneic hematopoietic stem-cell transplantation (HSCT) may provide cure in this scenario. We compared outcomes of HSCT from HLA-identical (HLA-id, n = 1654) sibling or haploidentical (Haplo, n = 389) donors in patients with R/R-AML, performed during the period 2007-2015. The Haplo group included patients receiving an unmanipulated graft (post-transplant cyclophosphamide, n = 278; in vivo T-cell depletion, n = 95; or both, n = 16). Median age at HSCT was 52 (range 18-74) years. Median follow-up was 16 and 22 months for HLA-id sibling and Haplo recipients, respectively (p = 0.11). Compared to MSD, Haplo HSCT were performed more recently (2013 vs 2011, p < 0.01), at longer interval from diagnosis (7 vs 5 months, p < 0.01), more frequently using bone marrow as stem cell source (47% vs 8%, p < 0.01) and with a reduced intensity conditioning regimen (50% vs 43%, p = 0.03). Engraftment was higher (93% vs 83%, p < 0.01) in HLA-id sibling. In multivariate analysis, Haplo HSCT was associated with lower GVHD/relapse-free survival, inferior LFS and OS and higher NRM, mainly due to a higher rate of infections (41% vs 25%, p < 0.01). For R/R-AML, HLA-id sibling donors remain the gold standard, when available, due to higher mortality in Haplo without significant gain in disease control.

Original languageEnglish
JournalBone Marrow Transplantation
DOIs
Publication statusE-pub ahead of print - Feb 4 2019

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Hematopoietic Stem Cell Transplantation
Acute Myeloid Leukemia
Siblings
Retrospective Studies
Tissue Donors
Transplants
Cyclophosphamide
Stem Cells
Multivariate Analysis
Bone Marrow
T-Lymphocytes
Recurrence
Survival
Mortality
Infection

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Unmanipulated haploidentical versus HLA-matched sibling allogeneic hematopoietic stem cell transplantation in relapsed/refractory acute myeloid leukemia : a retrospective study on behalf of the ALWP of the EBMT. / Battipaglia, Giorgia; Boumendil, Ariane; Labopin, Myriam; Ciceri, Fabio; Tischer, Johanna; Stelljes, Matthias; Ehninger, Gerhard; Beelen, Dietrich; Finke, Jürgen; Van Lint, Maria Teresa; Eder, Matthias; Afanasyev, Boris; Fanin, Renato; Mohty, Mohamad; Ruggeri, Annalisa; Nagler, Arnon.

In: Bone Marrow Transplantation, 04.02.2019.

Research output: Contribution to journalArticle

Battipaglia, Giorgia ; Boumendil, Ariane ; Labopin, Myriam ; Ciceri, Fabio ; Tischer, Johanna ; Stelljes, Matthias ; Ehninger, Gerhard ; Beelen, Dietrich ; Finke, Jürgen ; Van Lint, Maria Teresa ; Eder, Matthias ; Afanasyev, Boris ; Fanin, Renato ; Mohty, Mohamad ; Ruggeri, Annalisa ; Nagler, Arnon. / Unmanipulated haploidentical versus HLA-matched sibling allogeneic hematopoietic stem cell transplantation in relapsed/refractory acute myeloid leukemia : a retrospective study on behalf of the ALWP of the EBMT. In: Bone Marrow Transplantation. 2019.
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abstract = "Refractory or relapsed acute myeloid leukemia (R/R-AML) has poor prognosis. Allogeneic hematopoietic stem-cell transplantation (HSCT) may provide cure in this scenario. We compared outcomes of HSCT from HLA-identical (HLA-id, n = 1654) sibling or haploidentical (Haplo, n = 389) donors in patients with R/R-AML, performed during the period 2007-2015. The Haplo group included patients receiving an unmanipulated graft (post-transplant cyclophosphamide, n = 278; in vivo T-cell depletion, n = 95; or both, n = 16). Median age at HSCT was 52 (range 18-74) years. Median follow-up was 16 and 22 months for HLA-id sibling and Haplo recipients, respectively (p = 0.11). Compared to MSD, Haplo HSCT were performed more recently (2013 vs 2011, p < 0.01), at longer interval from diagnosis (7 vs 5 months, p < 0.01), more frequently using bone marrow as stem cell source (47{\%} vs 8{\%}, p < 0.01) and with a reduced intensity conditioning regimen (50{\%} vs 43{\%}, p = 0.03). Engraftment was higher (93{\%} vs 83{\%}, p < 0.01) in HLA-id sibling. In multivariate analysis, Haplo HSCT was associated with lower GVHD/relapse-free survival, inferior LFS and OS and higher NRM, mainly due to a higher rate of infections (41{\%} vs 25{\%}, p < 0.01). For R/R-AML, HLA-id sibling donors remain the gold standard, when available, due to higher mortality in Haplo without significant gain in disease control.",
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T1 - Unmanipulated haploidentical versus HLA-matched sibling allogeneic hematopoietic stem cell transplantation in relapsed/refractory acute myeloid leukemia

T2 - a retrospective study on behalf of the ALWP of the EBMT

AU - Battipaglia, Giorgia

AU - Boumendil, Ariane

AU - Labopin, Myriam

AU - Ciceri, Fabio

AU - Tischer, Johanna

AU - Stelljes, Matthias

AU - Ehninger, Gerhard

AU - Beelen, Dietrich

AU - Finke, Jürgen

AU - Van Lint, Maria Teresa

AU - Eder, Matthias

AU - Afanasyev, Boris

AU - Fanin, Renato

AU - Mohty, Mohamad

AU - Ruggeri, Annalisa

AU - Nagler, Arnon

PY - 2019/2/4

Y1 - 2019/2/4

N2 - Refractory or relapsed acute myeloid leukemia (R/R-AML) has poor prognosis. Allogeneic hematopoietic stem-cell transplantation (HSCT) may provide cure in this scenario. We compared outcomes of HSCT from HLA-identical (HLA-id, n = 1654) sibling or haploidentical (Haplo, n = 389) donors in patients with R/R-AML, performed during the period 2007-2015. The Haplo group included patients receiving an unmanipulated graft (post-transplant cyclophosphamide, n = 278; in vivo T-cell depletion, n = 95; or both, n = 16). Median age at HSCT was 52 (range 18-74) years. Median follow-up was 16 and 22 months for HLA-id sibling and Haplo recipients, respectively (p = 0.11). Compared to MSD, Haplo HSCT were performed more recently (2013 vs 2011, p < 0.01), at longer interval from diagnosis (7 vs 5 months, p < 0.01), more frequently using bone marrow as stem cell source (47% vs 8%, p < 0.01) and with a reduced intensity conditioning regimen (50% vs 43%, p = 0.03). Engraftment was higher (93% vs 83%, p < 0.01) in HLA-id sibling. In multivariate analysis, Haplo HSCT was associated with lower GVHD/relapse-free survival, inferior LFS and OS and higher NRM, mainly due to a higher rate of infections (41% vs 25%, p < 0.01). For R/R-AML, HLA-id sibling donors remain the gold standard, when available, due to higher mortality in Haplo without significant gain in disease control.

AB - Refractory or relapsed acute myeloid leukemia (R/R-AML) has poor prognosis. Allogeneic hematopoietic stem-cell transplantation (HSCT) may provide cure in this scenario. We compared outcomes of HSCT from HLA-identical (HLA-id, n = 1654) sibling or haploidentical (Haplo, n = 389) donors in patients with R/R-AML, performed during the period 2007-2015. The Haplo group included patients receiving an unmanipulated graft (post-transplant cyclophosphamide, n = 278; in vivo T-cell depletion, n = 95; or both, n = 16). Median age at HSCT was 52 (range 18-74) years. Median follow-up was 16 and 22 months for HLA-id sibling and Haplo recipients, respectively (p = 0.11). Compared to MSD, Haplo HSCT were performed more recently (2013 vs 2011, p < 0.01), at longer interval from diagnosis (7 vs 5 months, p < 0.01), more frequently using bone marrow as stem cell source (47% vs 8%, p < 0.01) and with a reduced intensity conditioning regimen (50% vs 43%, p = 0.03). Engraftment was higher (93% vs 83%, p < 0.01) in HLA-id sibling. In multivariate analysis, Haplo HSCT was associated with lower GVHD/relapse-free survival, inferior LFS and OS and higher NRM, mainly due to a higher rate of infections (41% vs 25%, p < 0.01). For R/R-AML, HLA-id sibling donors remain the gold standard, when available, due to higher mortality in Haplo without significant gain in disease control.

U2 - 10.1038/s41409-019-0459-7

DO - 10.1038/s41409-019-0459-7

M3 - Article

C2 - 30718798

JO - Bone Marrow Transplantation

JF - Bone Marrow Transplantation

SN - 0268-3369

ER -