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T-cell-depleted haploidentical stem cell transplantation results improve with time in adults with acute leukemia: A study from the Acute Leukemia Working Party of the European Society of Blood and Marrow Transplantation (EBMT).
Cancer. 2018 05 15; 124(10):2142-2150.C

Abstract

BACKGROUND

T-cell-depleted, haploidentical transplantations (haplos) are commonly offered to patients who have high-risk, acute leukemia in the absence of a human leukocyte antigen (HLA) full-matched donor.

METHODS

To determine the effect of transplantation period, the authors divided 308 adults with de novo, acute leukemia who underwent T-cell-depleted haplo from 2005 to 2015 into 2 groups, according the year in which they underwent transplantation (2005-2011 [n = 191] and 2012-2015 [n = 117]).

RESULTS

The median age was 41 years in patients who underwent transplantation before 2012 and 46 years in those who underwent transplantation after 2012 (P = .04). Most patients had acute myeloid leukemia (75% vs 69%; P = .26) and were in first complete remission (CR1) (55% vs 64%; P = .12) at the time of transplantation. The cumulative incidence of grade 2, 3, and 4 acute graft-versus-host disease (GvHD) and chronic GvHD were not different between the 2 groups (acute GvHD: 20% vs 22% cumulative incidence in patients who underwent haplo before and after 2012, respectively [P = .67]; chronic GvHD: 19% vs 11% cumulative incidence, respectively; P = .12]. The 2-year relapse incidence was 20%, the nonrelapse mortality (NRM) rate was 48%, and no difference was observed over time (21% vs 19% [P = .72] and 54% vs 38% [P = .11] for patients who underwent haplo before and after 2012, respectively). The main cause of NRM was infection. Haplo after 2012 (hazard ratio [HR], 0.57; P = .01), younger age (HR, 0.82; P = .02), and receipt of a reduced-intensity conditioning (RIC) regimen (HR, 0.53; P = .01) were independently associated with lower NRM. The 2-year overall survival rate was 36% and improved after 2012 (29% vs 47% before 2012; P = .02); and it was higher for patients who underwent transplantation in CR1 (41% vs 29%; P = .01). In multivariate analysis, haplo after 2012 (HR, 0.54; P = .003) and receipt of a RIC regimen (HR, 0.54; P = .005) were independently associated with better overall survival. Similarly, leukemia-free survival and GvHD-free/relapse-free survival (GRFS) improved over time: the leukemia-free survival rate was 31% (25% vs 43% in the groups who underwent transplantation before and after 2012, respectively; P = .05), and the GRFS rate was 24% (19% vs 34%, respectively; P = .09). In addition, leukemia-free survival and GRFS improved among patients who received a RIC regimen.

CONCLUSIONS

The outcome of patients with acute leukemia who underwent T-cell-depleted haplo has improved over time. Cancer 2018;124:2142-50. © 2018 American Cancer Society.

Authors+Show Affiliations

Hematology Clinic and Cellular Therapy, St. Antoine Hospital, Public Assistance Hospitals of Paris (AP-HP), Paris, France.European Society of Blood and Marrow Transplantation Paris Office, St. Antoine Hospital, Paris, France.Hematology Clinic and Cellular Therapy, St. Antoine Hospital, Public Assistance Hospitals of Paris (AP-HP), Paris, France. European Society of Blood and Marrow Transplantation Paris Office, St. Antoine Hospital, Paris, France. Eurocord, St. Louis Hospital AP-HP and University Institute of Hematology Paris VII, Paris, France.Hematology Section, Department of Clinical and Experimental Medicine, University of Perugia, Santa Maria della Perugia Hospital, Perugia, Italy.Department of Hematology and Bone Marrow Transplantation, Institute for Research and Health Care, San Raffaele Hospital, Milan, Italy.Department of Hematology, Gasthuisberg University Hospital, Leuven, Belgium.Medical Clinic, Tubingen University, Tubingen, Germany.Hematology Unit, Bone Marrow Transplant Center, University of Parma, Parma, Italy.Department of Hematology and Transplantation, Jules Bordet Institute, Brussels, Belgium.Third Clinic of Internal Medicine, Ulm University Clinic, Ulm, Germany.Hematology Clinic and Cellular Therapy, St. Antoine Hospital, Public Assistance Hospitals of Paris (AP-HP), Paris, France. European Society of Blood and Marrow Transplantation Paris Office, St. Antoine Hospital, Paris, France.European Society of Blood and Marrow Transplantation Paris Office, St. Antoine Hospital, Paris, France. Division of Hematology and Bone Marrow Transplantation, the Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29469924

Citation

Sestili, Simona, et al. "T-cell-depleted Haploidentical Stem Cell Transplantation Results Improve With Time in Adults With Acute Leukemia: a Study From the Acute Leukemia Working Party of the European Society of Blood and Marrow Transplantation (EBMT)." Cancer, vol. 124, no. 10, 2018, pp. 2142-2150.
Sestili S, Labopin M, Ruggeri A, et al. T-cell-depleted haploidentical stem cell transplantation results improve with time in adults with acute leukemia: A study from the Acute Leukemia Working Party of the European Society of Blood and Marrow Transplantation (EBMT). Cancer. 2018;124(10):2142-2150.
Sestili, S., Labopin, M., Ruggeri, A., Velardi, A., Ciceri, F., Maertens, J., Kanz, L., Aversa, F., Lewalle, P., Bunjes, D., Mohty, M., & Nagler, A. (2018). T-cell-depleted haploidentical stem cell transplantation results improve with time in adults with acute leukemia: A study from the Acute Leukemia Working Party of the European Society of Blood and Marrow Transplantation (EBMT). Cancer, 124(10), 2142-2150. https://doi.org/10.1002/cncr.31310
Sestili S, et al. T-cell-depleted Haploidentical Stem Cell Transplantation Results Improve With Time in Adults With Acute Leukemia: a Study From the Acute Leukemia Working Party of the European Society of Blood and Marrow Transplantation (EBMT). Cancer. 2018 05 15;124(10):2142-2150. PubMed PMID: 29469924.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - T-cell-depleted haploidentical stem cell transplantation results improve with time in adults with acute leukemia: A study from the Acute Leukemia Working Party of the European Society of Blood and Marrow Transplantation (EBMT). AU - Sestili,Simona, AU - Labopin,Myriam, AU - Ruggeri,Annalisa, AU - Velardi,Andrea, AU - Ciceri,Fabio, AU - Maertens,Johan, AU - Kanz,Lothar, AU - Aversa,Franco, AU - Lewalle,Philippe, AU - Bunjes,Donald, AU - Mohty,Mohamad, AU - Nagler,Arnon, Y1 - 2018/02/22/ PY - 2017/10/30/received PY - 2017/12/19/revised PY - 2018/01/17/accepted PY - 2018/2/23/pubmed PY - 2019/9/12/medline PY - 2018/2/23/entrez KW - T-cell depletion KW - acute leukemia KW - haploidentical transplantation KW - outcomes KW - time SP - 2142 EP - 2150 JF - Cancer JO - Cancer VL - 124 IS - 10 N2 - BACKGROUND: T-cell-depleted, haploidentical transplantations (haplos) are commonly offered to patients who have high-risk, acute leukemia in the absence of a human leukocyte antigen (HLA) full-matched donor. METHODS: To determine the effect of transplantation period, the authors divided 308 adults with de novo, acute leukemia who underwent T-cell-depleted haplo from 2005 to 2015 into 2 groups, according the year in which they underwent transplantation (2005-2011 [n = 191] and 2012-2015 [n = 117]). RESULTS: The median age was 41 years in patients who underwent transplantation before 2012 and 46 years in those who underwent transplantation after 2012 (P = .04). Most patients had acute myeloid leukemia (75% vs 69%; P = .26) and were in first complete remission (CR1) (55% vs 64%; P = .12) at the time of transplantation. The cumulative incidence of grade 2, 3, and 4 acute graft-versus-host disease (GvHD) and chronic GvHD were not different between the 2 groups (acute GvHD: 20% vs 22% cumulative incidence in patients who underwent haplo before and after 2012, respectively [P = .67]; chronic GvHD: 19% vs 11% cumulative incidence, respectively; P = .12]. The 2-year relapse incidence was 20%, the nonrelapse mortality (NRM) rate was 48%, and no difference was observed over time (21% vs 19% [P = .72] and 54% vs 38% [P = .11] for patients who underwent haplo before and after 2012, respectively). The main cause of NRM was infection. Haplo after 2012 (hazard ratio [HR], 0.57; P = .01), younger age (HR, 0.82; P = .02), and receipt of a reduced-intensity conditioning (RIC) regimen (HR, 0.53; P = .01) were independently associated with lower NRM. The 2-year overall survival rate was 36% and improved after 2012 (29% vs 47% before 2012; P = .02); and it was higher for patients who underwent transplantation in CR1 (41% vs 29%; P = .01). In multivariate analysis, haplo after 2012 (HR, 0.54; P = .003) and receipt of a RIC regimen (HR, 0.54; P = .005) were independently associated with better overall survival. Similarly, leukemia-free survival and GvHD-free/relapse-free survival (GRFS) improved over time: the leukemia-free survival rate was 31% (25% vs 43% in the groups who underwent transplantation before and after 2012, respectively; P = .05), and the GRFS rate was 24% (19% vs 34%, respectively; P = .09). In addition, leukemia-free survival and GRFS improved among patients who received a RIC regimen. CONCLUSIONS: The outcome of patients with acute leukemia who underwent T-cell-depleted haplo has improved over time. Cancer 2018;124:2142-50. © 2018 American Cancer Society. SN - 1097-0142 UR - https://www.unboundmedicine.com/medline/citation/29469924/T_cell_depleted_haploidentical_stem_cell_transplantation_results_improve_with_time_in_adults_with_acute_leukemia:_A_study_from_the_Acute_Leukemia_Working_Party_of_the_European_Society_of_Blood_and_Marrow_Transplantation__EBMT__ L2 - https://doi.org/10.1002/cncr.31310 DB - PRIME DP - Unbound Medicine ER -