• Armin Rashidi, Mehdi Hamadani, Mei-Jie Zhang, Hai-Lin Wang, Hisham Abdel-Azim, Mahmoud Aljurf, Amer Assal, Ashish Bajel, Asad Bashey, Minoo Battiwalla, Amer M Beitinjaneh, Nelli Bejanyan, Vijaya Raj Bhatt, Javier Bolaños-Meade, Michael Byrne, Jean-Yves Cahn, Mitchell Cairo, Stefan Ciurea, Edward Copelan, Corey Cutler, Andrew Daly, Miguel-Angel Diaz, Nosha Farhadfar, Robert P Gale, Siddhartha Ganguly, Michael R Grunwald, Theresa Hahn, Shahrukh Hashmi, Gerhard C Hildebrandt, H Kent Holland, Nasheed Hossain, Christopher G Kanakry, Mohamed A Kharfan-Dabaja, Nandita Khera, Yener Koc, Hillard M Lazarus, Jong-Wook Lee, Johan Maertens, Rodrigo Martino, Joseph McGuirk, Reinhold Munker, Hemant S Murthy, Ryotaro Nakamura, Sunita Nathan, Taiga Nishihori, Neil Palmisiano, Sagar Patel, Joseph Pidala, Rebecca Olin, Richard F Olsson, Betul Oran, Olov Ringden, David Rizzieri, Jacob Rowe, Mary Lynn Savoie, Kirk R Schultz, Sachiko Seo, Brian C Shaffer, Anurag Singh, Melhem Solh, Keith Stockerl-Goldstein, Leo F Verdonck, John Wagner, Edmund K Waller, Marcos De Lima, Brenda M Sandmaier, Mark Litzow, Dan Weisdorf, Rizwan Romee, and Wael Saber.
• Department of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN.
• Blood Adv. 2019 Jun 25; 3 (12): 1826-1836.

AbstractHLA-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.

43 keywords...

hide…