Outcomes of haploidentical vs matched sibling transplantation for acute myeloid leukemia in first complete remission. Journal Article

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Authors: Rashidi, A; Hamadani, M; Zhang, MJ; Wang, HL; Abdel-Azim, H; Aljurf, M; Assal, A; Bajel, A; Bashey, A; Battiwalla, M; Beitinjaneh, AM; Bejanyan, N; Bhatt, VR; Bolaños-Meade, J; Byrne, M; Cahn, JY; Cairo, M; Ciurea, S; Copelan, E; Cutler, C; Daly, A; Diaz, MA; Farhadfar, N; Gale, RP; Ganguly, S; Grunwald, MR; Hahn, T; Hashmi, S; Hildebrandt, GC; Holland, HK; Hossain, N; Kanakry, CG; Kharfan-Dabaja, MA; Khera, N; Koc, Y; Lazarus, HM; Lee, JW; Maertens, J; Martino, R; McGuirk, J; Munker, R; Murthy, HS; Nakamura, R; Nathan, S; Nishihori, T; Palmisiano, N; Patel, S; Pidala, J; Olin, R; Olsson, RF; Oran, B; Ringden, O; Rizzieri, D; Rowe, J; Savoie, ML; Schultz, KR; Seo, S; Shaffer, BC; Singh, A; Solh, M; Stockerl-Goldstein, K; Verdonck, LF; Wagner, J; Waller, EK; de Lima, M; Sandmaier, BM; Litzow, M; Weisdorf, D; Romee, R; Saber, W
Article Title: Outcomes of haploidentical vs matched sibling transplantation for acute myeloid leukemia in first complete remission.
Abstract: 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 ( = .15), leukemia-free survival ( = .50), nonrelapse mortality ( = .16), relapse ( = .90), or grade II-IV acute GVHD ( = .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; .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.
Journal Title: Blood advances
Publisher: Unknown  
Date Published: 2019