Outcome after allogeneic stem cell transplantation with haploidentical versus HLA-matched donors in patients with higher-risk MDS

Michel, Claire; Robin, Marie; Morisset, Stephane; Blaise, Didier; Maertens, Johan; Chevalier, Patrice; Castilla-Llorente, Cristina; Forcade, Edouard; Ceballos, Patrice; Yakoug-Agha, Ibrahim; Poire, Xavier; Carre, Martin; Bay, Jacques-Olivier; Beguin, Yves; Loschi, Michael; Huynh, Anne; Guillerm, Gaelle; Francois, Sylvie; Mear, Jean-Baptiste; Dulery, Remy; Suarez, Felipe; Bilger, Karin; Cornillon, Jerome; Chalandon, Yves; Maillard, Natacha; Labussiere-Wallet, Helene; Charbonnier, Amandine; Turlure, Pascal; Berceanu, Ana; Chantepie, Sylvain; Maury, Sebastien; Bazarbachi, Ali; Menard, Anne-Lise; Nguyen-Quoc, Stephanie; Rubio, Marie-Therese; D'Aveni, Maud

doi:10.1038/s41409-023-01931-7

Outcome after allogeneic stem cell transplantation with haploidentical versus HLA-matched donors in patients with higher-risk MDS

Author:

Michel, Claire

Robin, Marie ; Morisset, Stephane ; Blaise, Didier ; Maertens, Johan ; Chevalier, Patrice ; Castilla-Llorente, Cristina ; Forcade, Edouard ; Ceballos, Patrice ; Yakoug-Agha, Ibrahim ; Poire, Xavier ; Carre, Martin ; Bay, Jacques-Olivier ; Beguin, Yves ; Loschi, Michael ; Huynh, Anne ; Guillerm, Gaelle ; Francois, Sylvie ; Mear, Jean-Baptiste ; Dulery, Remy ; Suarez, Felipe ; Bilger, Karin ; Cornillon, Jerome ; Chalandon, Yves ; Maillard, Natacha ; Labussiere-Wallet, Helene ; Charbonnier, Amandine ; Turlure, Pascal ; Berceanu, Ana ; Chantepie, Sylvain ; Maury, Sebastien ; Bazarbachi, Ali ; Menard, Anne-Lise ; Nguyen-Quoc, Stephanie ; Rubio, Marie-Therese ; D'Aveni, Maud

Keywords:

Science & Technology, Life Sciences & Biomedicine, Biophysics, Oncology, Hematology, Immunology, Transplantation, PROGNOSTIC SCORING SYSTEM, ACUTE MYELOID-LEUKEMIA, VERSUS-HOST-DISEASE, MYELODYSPLASTIC SYNDROME, POSTTRANSPLANT CYCLOPHOSPHAMIDE, SFGM-TC, CYTOGENETICS, REMISSION, DIAGNOSIS, SURVIVAL, Humans, Hematopoietic Stem Cell Transplantation, Leukemia, Myeloid, Acute, Tissue Donors, Acute Disease, Transplantation, Homologous, Graft vs Host Disease, Transplantation Conditioning, Unrelated Donors, Retrospective Studies, Siblings, 1103 Clinical Sciences, 1112 Oncology and Carcinogenesis, 3201 Cardiovascular medicine and haematology, 3211 Oncology and carcinogenesis

Abstract:

Allogeneic hematopoietic stem cell transplantation remains the best curative option for higher-risk myelodysplastic syndrome. The presence of monosomal karyotype and/or complex karyotype abnormalities predicts inferior survival after allo-SCT in MDS patients. Haploidentical allo-SCT has been increasingly used in acute leukemia (AL) and has similar results as using HLA-matched donors, but data on higher-risk MDS is sparse. We compared outcomes in 266 patients with higher-risk MDS after HLA-matched sibling donor (MSD, n = 79), HLA-matched unrelated donor (MUD, n = 139) and HLA haploidentical donor (HID, n = 48) from 2010 to 2019. Median donor age differed between the three groups (p < 0.001). The overall survival was significantly different between the three groups with a better OS observed in the MUD group (p = 0.014). This observation could be explained by a higher progression-free survival with MUD (p = 0.014). The cumulative incidence of grade 2-4 acute GvHD was significantly higher in the HID group (p = 0.051). However, in multivariable analysis, patients transplanted using an HID had comparable mortality to patients transplanted using a MUD (subdistribution hazard ratio [sHR]: 0.58 [0.32-1.07]; p = 0.080) and a MSD ([sHR]: 0.56 [0.28-1.11]; p = 0.094). MUD do not remain a significant positive predictor of survival, suggesting that beyond the donor-recipient HLA matching, the donor age might impact recipient outcome.