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

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

doi:10.1182/bloodadvances.2019000050

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

Author:

Rashidi, Armin

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

Keywords:

Science & Technology, Life Sciences & Biomedicine, Hematology, HEMATOPOIETIC-CELL TRANSPLANTATION, UNRELATED DONOR TRANSPLANTATION, CORD-BLOOD TRANSPLANTATION, QUALITY-OF-LIFE, POSTTRANSPLANTATION CYCLOPHOSPHAMIDE, BONE-MARROW, EUROPEAN-SOCIETY, WORKING PARTY, STEM-CELLS, SURVIVAL, 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, 3201 Cardiovascular medicine and haematology

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.