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Haploidentical vs sibling, unrelated, or cord blood hematopoietic cell transplantation for acute lymphoblastic leukemia. Blood Adv 2022 Jan 11;6(1):339-357

Date

09/22/2021

Pubmed ID

34547770

Pubmed Central ID

PMC8753217

DOI

10.1182/bloodadvances.2021004916

Abstract

The role of haploidentical hematopoietic cell transplantation (HCT) using posttransplant cyclophosphamide (PTCy) for acute lymphoblastic leukemia (ALL) is being defined. We performed a retrospective, multivariable analysis comparing outcomes of HCT approaches by donor for adults with ALL in remission. The primary objective was to compare overall survival (OS) among haploidentical HCTs using PTCy and HLA-matched sibling donor (MSD), 8/8 HLA-matched unrelated donor (MUD), 7 /8 HLA-MUD, or umbilical cord blood (UCB) HCT. Comparing haploidentical HCT to MSD HCT, we found that OS, leukemia-free survival (LFS), nonrelapse mortality (NRM), relapse, and acute graft-versus-host disease (aGVHD) were not different but chronic GVHD (cGVHD) was higher in MSD HCT. Compared with MUD HCT, OS, LFS, and relapse were not different, but MUD HCT had increased NRM (hazard ratio [HR], 1.42; P = .02), grade 3 to 4 aGVHD (HR, 1.59; P = .005), and cGVHD. Compared with 7/8 UD HCT, LFS and relapse were not different, but 7/8 UD HCT had worse OS (HR, 1.38; P = .01) and increased NRM (HR, 2.13; P ≤ .001), grade 3 to 4 aGVHD (HR, 1.86; P = .003), and cGVHD (HR, 1.72; P ≤ .001). Compared with UCB HCT, late OS, late LFS, relapse, and cGVHD were not different but UCB HCT had worse early OS (≤18 months; HR, 1.93; P < .001), worse early LFS (HR, 1.40; P = .007) and increased incidences of NRM (HR, 2.08; P < .001) and grade 3 to 4 aGVHD (HR, 1.97; P < .001). Haploidentical HCT using PTCy showed no difference in survival but less GVHD compared with traditional MSD and MUD HCT and is the preferred alternative donor HCT option for adults with ALL in complete remission.

Author List

Wieduwilt MJ, Metheny L, Zhang MJ, Wang HL, Estrada-Merly N, Marks DI, Al-Homsi AS, Muffly L, Chao N, Rizzieri D, Gale RP, Gadalla SM, Cairo M, Mussetti A, Gore S, Bhatt VR, Patel SS, Michelis FV, Inamoto Y, Badawy SM, Copelan E, Palmisiano N, Kharfan-Dabaja MA, Lazarus HM, Ganguly S, Bredeson C, Diaz Perez MA, Cassaday R, Savani BN, Ballen K, Martino R, Wirk B, Bacher U, Aljurf M, Bashey A, Murthy HS, Yared JA, Aldoss I, Farhadfar N, Liu H, Abdel-Azim H, Waller EK, Solh M, Seftel MD, van der Poel M, Grunwald MR, Liesveld JL, Kamble RT, McGuirk J, Munker R, Cahn JY, Lee JW, Freytes CO, Krem MM, Winestone LE, Gergis U, Nathan S, Olsson RF, Verdonck LF, Sharma A, Ringdén O, Friend BD, Cerny J, Choe H, Chhabra S, Nishihori T, Seo S, George B, Baxter-Lowe LA, Hildebrandt GC, de Lima M, Litzow M, Kebriaei P, Hourigan CS, Abid MB, Weisdorf DJ, Saber W

Authors

Muhammad Bilal Abid MD Assistant Professor in the Medicine department at Medical College of Wisconsin
Saurabh Chhabra MD Associate 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