Outcomes of haploidentical vs matched sibling transplantation for acute myeloid leukemia in first complete remission
HLA-haploidentical hematopoietic cell transplantation (Haplo-HCT) using posttransplantation cyclophosphamide (PT-Cy) has improved donor availability. However, a matched sibling donor (MSD) is still considered the optimal donor. Using the Center for International Blood and Marrow Transplant Research database, we compared outcomes after Haplo-HCT vs MSD in patients with acute myeloid leukemia (AML) in first complete remission (CR1). Data from 1205 adult CR1 AML patients (2008-2015) were analyzed. A total of 336 patients underwent PT-Cy-based Haplo-HCT and 869 underwent MSD using calcineurin inhibitor-based graft-versus-host disease (GVHD) prophylaxis. The Haplo-HCT group included more reduced-intensity conditioning (65% vs 30%) and bone marrow grafts (62% vs 7%), consistent with current practice. In multivariable analysis, Haplo-HCT and MSD groups were not different with regard to overall survival (P = .15), leukemia-free survival (P = .50), nonrelapse mortality (P = .16), relapse (P = .90), or grade II-IV acute GVHD (P = .98). However, the Haplo-HCT group had a significantly lower rate of chronic GVHD (hazard ratio, 0.38; 95% confidence interval, 0.30-0.48; P < .001). Results of subgroup analyses by conditioning intensity and graft source suggested that the reduced incidence of chronic GVHD in Haplo-HCT is not limited to a specific graft source or conditioning intensity. Center effect and minimal residual disease-donor type interaction were not predictors of outcome. Our results indicate a lower rate of chronic GVHD after PT-Cy-based Haplo-HCT vs MSD using calcineurin inhibitor-based GVHD prophylaxis, but similar other outcomes, in patients with AML in CR1. Haplo-HCT is a viable alternative to MSD in these patients.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2019 |
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| Erschienen: |
2019 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:3 |
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| Enthalten in: |
Blood advances - 3(2019), 12 vom: 25. Juni, Seite 1826-1836 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Rashidi, Armin [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 15.06.2020 Date Revised 27.08.2020 published: Print Citation Status MEDLINE |
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| doi: |
10.1182/bloodadvances.2019000050 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM298177854 |
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| 245 | 1 | 0 | |a Outcomes of haploidentical vs matched sibling transplantation for acute myeloid leukemia in first complete remission |
| 264 | 1 | |c 2019 | |
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| 500 | |a Date Completed 15.06.2020 | ||
| 500 | |a Date Revised 27.08.2020 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a HLA-haploidentical hematopoietic cell transplantation (Haplo-HCT) using posttransplantation cyclophosphamide (PT-Cy) has improved donor availability. However, a matched sibling donor (MSD) is still considered the optimal donor. Using the Center for International Blood and Marrow Transplant Research database, we compared outcomes after Haplo-HCT vs MSD in patients with acute myeloid leukemia (AML) in first complete remission (CR1). Data from 1205 adult CR1 AML patients (2008-2015) were analyzed. A total of 336 patients underwent PT-Cy-based Haplo-HCT and 869 underwent MSD using calcineurin inhibitor-based graft-versus-host disease (GVHD) prophylaxis. The Haplo-HCT group included more reduced-intensity conditioning (65% vs 30%) and bone marrow grafts (62% vs 7%), consistent with current practice. In multivariable analysis, Haplo-HCT and MSD groups were not different with regard to overall survival (P = .15), leukemia-free survival (P = .50), nonrelapse mortality (P = .16), relapse (P = .90), or grade II-IV acute GVHD (P = .98). However, the Haplo-HCT group had a significantly lower rate of chronic GVHD (hazard ratio, 0.38; 95% confidence interval, 0.30-0.48; P < .001). Results of subgroup analyses by conditioning intensity and graft source suggested that the reduced incidence of chronic GVHD in Haplo-HCT is not limited to a specific graft source or conditioning intensity. Center effect and minimal residual disease-donor type interaction were not predictors of outcome. Our results indicate a lower rate of chronic GVHD after PT-Cy-based Haplo-HCT vs MSD using calcineurin inhibitor-based GVHD prophylaxis, but similar other outcomes, in patients with AML in CR1. Haplo-HCT is a viable alternative to MSD in these patients | ||
| 650 | 4 | |a Comparative Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Research Support, U.S. Gov't, Non-P.H.S. | |
| 650 | 4 | |a Research Support, U.S. Gov't, P.H.S. | |
| 650 | 7 | |a Calcineurin Inhibitors |2 NLM | |
| 650 | 7 | |a Immunosuppressive Agents |2 NLM | |
| 650 | 7 | |a Cyclophosphamide |2 NLM | |
| 650 | 7 | |a 8N3DW7272P |2 NLM | |
| 700 | 1 | |a Hamadani, Mehdi |e verfasserin |4 aut | |
| 700 | 1 | |a Zhang, Mei-Jie |e verfasserin |4 aut | |
| 700 | 1 | |a Wang, Hai-Lin |e verfasserin |4 aut | |
| 700 | 1 | |a Abdel-Azim, Hisham |e verfasserin |4 aut | |
| 700 | 1 | |a Aljurf, Mahmoud |e verfasserin |4 aut | |
| 700 | 1 | |a Assal, Amer |e verfasserin |4 aut | |
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| 700 | 1 | |a Beitinjaneh, Amer M |e verfasserin |4 aut | |
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| 700 | 1 | |a Bhatt, Vijaya Raj |e verfasserin |4 aut | |
| 700 | 1 | |a Bolaños-Meade, Javier |e verfasserin |4 aut | |
| 700 | 1 | |a Byrne, Michael |e verfasserin |4 aut | |
| 700 | 1 | |a Cahn, Jean-Yves |e verfasserin |4 aut | |
| 700 | 1 | |a Cairo, Mitchell |e verfasserin |4 aut | |
| 700 | 1 | |a Ciurea, Stefan |e verfasserin |4 aut | |
| 700 | 1 | |a Copelan, Edward |e verfasserin |4 aut | |
| 700 | 1 | |a Cutler, Corey |e verfasserin |4 aut | |
| 700 | 1 | |a Daly, Andrew |e verfasserin |4 aut | |
| 700 | 1 | |a Diaz, Miguel-Angel |e verfasserin |4 aut | |
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| 700 | 1 | |a Gale, Robert P |e verfasserin |4 aut | |
| 700 | 1 | |a Ganguly, Siddhartha |e verfasserin |4 aut | |
| 700 | 1 | |a Grunwald, Michael R |e verfasserin |4 aut | |
| 700 | 1 | |a Hahn, Theresa |e verfasserin |4 aut | |
| 700 | 1 | |a Hashmi, Shahrukh |e verfasserin |4 aut | |
| 700 | 1 | |a Hildebrandt, Gerhard C |e verfasserin |4 aut | |
| 700 | 1 | |a Holland, H Kent |e verfasserin |4 aut | |
| 700 | 1 | |a Hossain, Nasheed |e verfasserin |4 aut | |
| 700 | 1 | |a Kanakry, Christopher G |e verfasserin |4 aut | |
| 700 | 1 | |a Kharfan-Dabaja, Mohamed A |e verfasserin |4 aut | |
| 700 | 1 | |a Khera, Nandita |e verfasserin |4 aut | |
| 700 | 1 | |a Koc, Yener |e verfasserin |4 aut | |
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| 700 | 1 | |a Munker, Reinhold |e verfasserin |4 aut | |
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| 700 | 1 | |a Palmisiano, Neil |e verfasserin |4 aut | |
| 700 | 1 | |a Patel, Sagar |e verfasserin |4 aut | |
| 700 | 1 | |a Pidala, Joseph |e verfasserin |4 aut | |
| 700 | 1 | |a Olin, Rebecca |e verfasserin |4 aut | |
| 700 | 1 | |a Olsson, Richard F |e verfasserin |4 aut | |
| 700 | 1 | |a Oran, Betul |e verfasserin |4 aut | |
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