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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.
J Hematol Oncol. 2018 04 16; 11(1):55.JH

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.

Authors+Show Affiliations

Department of Hematology and Cell Therapy, Saint-Antoine Hospital, Paris, France. nicole.santoro24@gmail.com. Section of Hematology, Department of Medicine, University of Perugia, Centro Ricerche Emato-Oncologiche (CREO), Perugia, Italy. nicole.santoro24@gmail.com.Department of Hematology and Cell Therapy, Saint-Antoine Hospital, Paris, France. ALWP office, Hôpital Saint-Antoine, Paris, France.Department of Hematology and Cell Therapy, Saint-Antoine Hospital, Paris, France.Medical Clinic and Policlinic I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany.Department of Hematology and Oncology, University of Leipzig, Leipzig, Germany.Center for Blood Stem Cell and Bone Marrow Transplant, DKD Helios Clinic Wiesbaden, Wiesbaden, Germany.Department of Medicine A/Hematology and Oncology, University of Muenster, Muenster, Germany.Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.Department of Internal Medicine II, University Hospital Wurzburg, Würzburg, Germany.Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany.Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital of Cologne, Cologne, Germany.Department of Hematology and Oncology, Asklepios Klinik St. Georg Hamburg, Hamburg, Germany.Department of Medicine-Hematology, Oncology, University of Freiburg, Freiburg, Germany.Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.Department of Hematology and Cell Therapy, Saint-Antoine Hospital, Paris, France.Department of Hematology and Cell Therapy, Saint-Antoine Hospital, Paris, France. Department of Pediatric Hematology and Oncology, IRCCS Bambino Gesù Children's Hospital, Piazza S Onofrio, 4, 00165, Rome, Italy.ALWP office, Hôpital Saint-Antoine, Paris, France. Department of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Israel.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29661208

Citation

Santoro, Nicole, et al. "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 & Oncology, vol. 11, no. 1, 2018, p. 55.
Santoro N, Labopin M, Giannotti F, et al. 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. J Hematol Oncol. 2018;11(1):55.
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 & Oncology, 11(1), 55. https://doi.org/10.1186/s13045-018-0598-0
Santoro N, et al. 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. J Hematol Oncol. 2018 04 16;11(1):55. PubMed PMID: 29661208.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Santoro,Nicole, AU - Labopin,Myriam, AU - Giannotti,Federica, AU - Ehninger,Gerard, AU - Niederwieser,Dietger, AU - Brecht,Arne, AU - Stelljes,Matthias, AU - Kröger,Nicolaus, AU - Einsele,Herman, AU - Eder,Matthias, AU - Hallek,Michael, AU - Glass,Bertram, AU - Finke,Jürgen, AU - Ciceri,Fabio, AU - Mohty,Mohamad, AU - Ruggeri,Annalisa, AU - Nagler,Arnon, Y1 - 2018/04/16/ PY - 2018/02/16/received PY - 2018/03/29/accepted PY - 2018/4/18/entrez PY - 2018/4/18/pubmed PY - 2019/10/28/medline KW - Acute myeloid leukemia KW - Allogeneic stem cell transplantation KW - Elderly KW - Haploidentical KW - MUD SP - 55 EP - 55 JF - Journal of hematology & oncology JO - J Hematol Oncol VL - 11 IS - 1 N2 - 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. SN - 1756-8722 UR - https://www.unboundmedicine.com/medline/citation/29661208/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_ L2 - https://jhoonline.biomedcentral.com/articles/10.1186/s13045-018-0598-0 DB - PRIME DP - Unbound Medicine ER -