Faculty Collaboration Database

Outcomes of haploidentical vs matched sibling transplantation for acute myeloid leukemia in first complete remission. Blood Adv 2019 Jun 25;3(12):1826-1836

Date

06/16/2019

Pubmed ID

31201170

Pubmed Central ID

PMC6595262

DOI

10.1182/bloodadvances.2019000050

Scopus ID

2-s2.0-85068734856 (requires institutional sign-in at Scopus site)   83 Citations

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 (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.

Author List

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

Authors

Mehdi H. Hamadani MD Professor in the Medicine department at Medical College of Wisconsin
Wael Saber MD, MS Professor in the Medicine department at Medical College of Wisconsin
Mei-Jie Zhang PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Blood Donors
Bone Marrow Transplantation
Calcineurin Inhibitors
Chronic Disease
Cyclophosphamide
Disease-Free Survival
Female
Graft vs Host Disease
Hematopoietic Stem Cell Transplantation
Humans
Immunosuppressive Agents
Incidence
Leukemia, Myeloid, Acute
Male
Middle Aged
Recurrence
Remission Induction
Retrospective Studies
Siblings
Survival Analysis
Transplantation Conditioning
Transplantation, Haploidentical
Young Adult