Post-transplant cyclophosphamide in one-antigen mismatched unrelated donor transplantation versus haploidentical transplantation in acute myeloid leukemia: a study from the Acute Leukemia Working Party of the EBMT.

Abstract

Whether to choose Haploidentical (Haplo) or one-antigen mismatched unrelated donor (1Ag-MMUD) hematopoietic cell transplantation (HCT) with post-transplant cyclophosphamide (PTCy) remains an unanswered question. We compared PTCy- Haplo-HCT to PTCy-1Ag-MMUD-HCT for acute myeloid leukemia (AML) in complete remission (three groups: 1Ag-MMUD using peripheral blood (1Ag-MMUD-PB; n = 155); Haplo using bone marrow (Haplo-BM; n = 647) or peripheral blood (Haplo-PB; n = 949)). Haplo-BM and Haplo-PB had a higher non-relapse mortality (NRM) compared to 1Ag-MMUD-PB (HR 2.28, 95% CI 1.23-4.24, p < 0.01; HR 2.65, 95% CI 1.46-4.81, p < 0.01, respectively). Haplo groups experienced a lower leukemia-free survival (LFS) compared to 1Ag-MMUD-PB (Haplo-BM: HR 1.51, 95% CI 1.06-2.14, p = 0.02; Haplo-PB: 1.47, 95% CI 1.05-2.05, p = 0.02); overall survival (OS) was also lower in Haplo-HCT (Haplo-BM: HR 1.50, 95% CI 1.02-2.21, p = 0.04; Haplo-PB: HR 1.51, 95% CI 1.05-2.19, p = 0.03). No differences were observed for graft-versus-host/relapse-free survival (GRFS) and relapse incidence (RI). Haplo-BM was associated with a lower risk of grade III-IV acute graft-versus-host disease (GVHD) (HR 0.44, 95% CI 0.24-0.81; p < 0.01), while no statistical differences were observed between groups for grade II-IV aGVHD and for cGVHD. Use of PTCy in 1Ag-MMUD-HCT is a valid alternative to consider when using alternative donors. Larger analysis of 1Ag-MMUD versus Haplo-HCT are warranted.

• Authors: Giorgia Battipaglia, Jacques-Emmanuel Galimard, Myriam Labopin, Anna Maria Raiola, Didier Blaise, Annalisa Ruggeri, Yener Koc, Zafer Gülbas, Antonin Vitek, Simona Sica, Jose Luiz Diez-Martin, Luca Castagna, Benedetto Bruno, Montserrat Rovira, Ivan Moiseev, Massimo Martino, Giovanni Grillo, Mercedes Colorado Araujo, Claude Eric Bulabois, Stéphanie Nguyen, Gerard Socié, Mutlu Arat, Jiri Pavlu, Johanna Tischer, Hans Martin, Lucia Lopez Corral, Goda Choi, Edouard Forcade, Andrew McDonald, Fabrizio Pane, Ali Bazarbachi, Fabio Ciceri, Arnon Nagler, Mohamad Mohty
• Journal: Bone marrow transplantation (Bone Marrow Transplant) Vol. 57 Issue 4 Pg. 562-571 (04 2022) ISSN: 1476-5365 [Electronic] England
• PMID: 35079140 (Publication Type: Journal Article)
• Copyright: © 2022. The Author(s), under exclusive licence to Springer Nature Limited.

Chemical References

• Cyclophosphamide

Topics

• Cyclophosphamide (pharmacology, therapeutic use)
• Graft vs Host Disease
• Hematopoietic Stem Cell Transplantation
• Humans
• Leukemia, Myeloid, Acute (therapy)
• Retrospective Studies
• Transplantation Conditioning
• Transplantation, Haploidentical
• Unrelated Donors