Haploidentical transplant with posttransplant cyclophosphamide vs matched unrelated donor transplant for acute myeloid leukemia

Stefan O. Ciurea; Mei Jie Zhang; Andrea A. Bacigalupo; Asad Bashey; Frederick R. Appelbaum; Omar S. Aljitawi; Philippe Armand; Joseph H. Antin; Junfang Chen; Steven M. Devine; Daniel H. Fowler; Leo Luznik; Ryotaro Nakamura; Paul V. O'Donnell; Miguel Angel Perales; Sai Ravi Pingali; David L. Porter; Marcie R. Riches; Olle T H Ringdén; Vanderson Rocha; Ravi Vij; Daniel J. Weisdorf; Richard E. Champlin; Mary M. Horowitz; Ephraim J. Fuchs; Mary Eapen

doi:10.1182/blood-2015-04-639831

Haploidentical transplant with posttransplant cyclophosphamide vs matched unrelated donor transplant for acute myeloid leukemia

Stefan O. Ciurea, Mei Jie Zhang, Andrea A. Bacigalupo, Asad Bashey, Frederick R. Appelbaum, Omar S. Aljitawi, Philippe Armand, Joseph H. Antin, Junfang Chen, Steven M. Devine, Daniel H. Fowler, Leo Luznik, Ryotaro Nakamura, Paul V. O'Donnell, Miguel Angel Perales, Sai Ravi Pingali, David L. Porter, Marcie R. Riches, Olle T H Ringdén, Vanderson RochaRavi Vij, Daniel J. Weisdorf, Richard E. Champlin, Mary M. Horowitz, Ephraim J. Fuchs, Mary Eapen

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Abstract

We studied adults with acute myeloid leukemia (AML) after haploidentical (n = 192) and 8/8 HLA-matched unrelated donor (n = 1982) transplantation. Haploidentical recipients received calcineurin inhibitor (CNI), mycophenolate, and posttransplant cyclophosphamide for graft-versus-host disease (GVHD) prophylaxis; 104 patients received myeloablative and 88 received reduced intensity conditioning regimens. Matched unrelated donor transplant recipients received CNI with mycophenolate or methotrexate for GVHD prophylaxis; 1245 patients received myeloablative and 737 received reduced intensity conditioning regimens. In the myeloablative setting, day 30 neutrophil recovery was lower after haploidentical compared with matched unrelated donor transplants (90% vs 97%, P = .02). Corresponding rates after reduced intensity conditioning transplants were 93% and 96% (P = .25). In the myeloablative setting, 3-month acute grade 2-4 (16% vs 33%, P < .0001) and 3-year chronic GVHD (30% vs 53%, P < .0001) were lower after haploidentical compared with matched unrelated donor transplants. Similar differences were observed after reduced intensity conditioning transplants, 19% vs 28% (P = .05) and 34% vs 52% (P = .002). Among patients receiving myeloablative regimens, 3-year probabilities of overall survival were 45% (95% CI, 36-54) and 50% (95% CI, 47-53) after haploidentical and matched unrelated donor transplants (P = .38). Corresponding rates after reduced intensity conditioning transplants were 46% (95% CI, 35-56) and 44% (95% CI, 0.40-47) (P = .71). Although statistical power is limited, these data suggests that survival for patients with AML after haploidentical transplantation with posttransplant cyclophosphamide is comparable with matched unrelated donor transplantation.

Original language	English (US)
Pages (from-to)	1033-1040
Number of pages	8
Journal	Blood
Volume	126
Issue number	8
DOIs	https://doi.org/10.1182/blood-2015-04-639831
State	Published - Aug 20 2015

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© 2015, American Society of Hematology. All rights reserved.

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Ciurea, S. O., Zhang, M. J., Bacigalupo, A. A., Bashey, A., Appelbaum, F. R., Aljitawi, O. S., Armand, P., Antin, J. H., Chen, J., Devine, S. M., Fowler, D. H., Luznik, L., Nakamura, R., O'Donnell, P. V., Perales, M. A., Pingali, S. R., Porter, D. L., Riches, M. R., Ringdén, O. T. H., ... Eapen, M. (2015). Haploidentical transplant with posttransplant cyclophosphamide vs matched unrelated donor transplant for acute myeloid leukemia. Blood, 126(8), 1033-1040. https://doi.org/10.1182/blood-2015-04-639831

Ciurea, SO, Zhang, MJ, Bacigalupo, AA, Bashey, A, Appelbaum, FR, Aljitawi, OS, Armand, P, Antin, JH, Chen, J, Devine, SM, Fowler, DH, Luznik, L, Nakamura, R, O'Donnell, PV, Perales, MA, Pingali, SR, Porter, DL, Riches, MR, Ringdén, OTH, Rocha, V, Vij, R, Weisdorf, DJ, Champlin, RE, Horowitz, MM, Fuchs, EJ & Eapen, M 2015, 'Haploidentical transplant with posttransplant cyclophosphamide vs matched unrelated donor transplant for acute myeloid leukemia', Blood, vol. 126, no. 8, pp. 1033-1040. https://doi.org/10.1182/blood-2015-04-639831

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title = "Haploidentical transplant with posttransplant cyclophosphamide vs matched unrelated donor transplant for acute myeloid leukemia",

abstract = "We studied adults with acute myeloid leukemia (AML) after haploidentical (n = 192) and 8/8 HLA-matched unrelated donor (n = 1982) transplantation. Haploidentical recipients received calcineurin inhibitor (CNI), mycophenolate, and posttransplant cyclophosphamide for graft-versus-host disease (GVHD) prophylaxis; 104 patients received myeloablative and 88 received reduced intensity conditioning regimens. Matched unrelated donor transplant recipients received CNI with mycophenolate or methotrexate for GVHD prophylaxis; 1245 patients received myeloablative and 737 received reduced intensity conditioning regimens. In the myeloablative setting, day 30 neutrophil recovery was lower after haploidentical compared with matched unrelated donor transplants (90% vs 97%, P = .02). Corresponding rates after reduced intensity conditioning transplants were 93% and 96% (P = .25). In the myeloablative setting, 3-month acute grade 2-4 (16% vs 33%, P < .0001) and 3-year chronic GVHD (30% vs 53%, P < .0001) were lower after haploidentical compared with matched unrelated donor transplants. Similar differences were observed after reduced intensity conditioning transplants, 19% vs 28% (P = .05) and 34% vs 52% (P = .002). Among patients receiving myeloablative regimens, 3-year probabilities of overall survival were 45% (95% CI, 36-54) and 50% (95% CI, 47-53) after haploidentical and matched unrelated donor transplants (P = .38). Corresponding rates after reduced intensity conditioning transplants were 46% (95% CI, 35-56) and 44% (95% CI, 0.40-47) (P = .71). Although statistical power is limited, these data suggests that survival for patients with AML after haploidentical transplantation with posttransplant cyclophosphamide is comparable with matched unrelated donor transplantation.",

author = "Ciurea, {Stefan O.} and Zhang, {Mei Jie} and Bacigalupo, {Andrea A.} and Asad Bashey and Appelbaum, {Frederick R.} and Aljitawi, {Omar S.} and Philippe Armand and Antin, {Joseph H.} and Junfang Chen and Devine, {Steven M.} and Fowler, {Daniel H.} and Leo Luznik and Ryotaro Nakamura and O'Donnell, {Paul V.} and Perales, {Miguel Angel} and Pingali, {Sai Ravi} and Porter, {David L.} and Riches, {Marcie R.} and Ringd{\'e}n, {Olle T H} and Vanderson Rocha and Ravi Vij and Weisdorf, {Daniel J.} and Champlin, {Richard E.} and Horowitz, {Mary M.} and Fuchs, {Ephraim J.} and Mary Eapen",

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doi = "10.1182/blood-2015-04-639831",

language = "English (US)",

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T1 - Haploidentical transplant with posttransplant cyclophosphamide vs matched unrelated donor transplant for acute myeloid leukemia

AU - Ciurea, Stefan O.

AU - Zhang, Mei Jie

AU - Bacigalupo, Andrea A.

AU - Bashey, Asad

AU - Appelbaum, Frederick R.

AU - Aljitawi, Omar S.

AU - Armand, Philippe

AU - Antin, Joseph H.

AU - Chen, Junfang

AU - Devine, Steven M.

AU - Fowler, Daniel H.

AU - Luznik, Leo

AU - Nakamura, Ryotaro

AU - O'Donnell, Paul V.

AU - Perales, Miguel Angel

AU - Pingali, Sai Ravi

AU - Porter, David L.

AU - Riches, Marcie R.

AU - Ringdén, Olle T H

AU - Rocha, Vanderson

AU - Vij, Ravi

AU - Weisdorf, Daniel J.

AU - Champlin, Richard E.

AU - Horowitz, Mary M.

AU - Fuchs, Ephraim J.

AU - Eapen, Mary

PY - 2015/8/20

Y1 - 2015/8/20

N2 - We studied adults with acute myeloid leukemia (AML) after haploidentical (n = 192) and 8/8 HLA-matched unrelated donor (n = 1982) transplantation. Haploidentical recipients received calcineurin inhibitor (CNI), mycophenolate, and posttransplant cyclophosphamide for graft-versus-host disease (GVHD) prophylaxis; 104 patients received myeloablative and 88 received reduced intensity conditioning regimens. Matched unrelated donor transplant recipients received CNI with mycophenolate or methotrexate for GVHD prophylaxis; 1245 patients received myeloablative and 737 received reduced intensity conditioning regimens. In the myeloablative setting, day 30 neutrophil recovery was lower after haploidentical compared with matched unrelated donor transplants (90% vs 97%, P = .02). Corresponding rates after reduced intensity conditioning transplants were 93% and 96% (P = .25). In the myeloablative setting, 3-month acute grade 2-4 (16% vs 33%, P < .0001) and 3-year chronic GVHD (30% vs 53%, P < .0001) were lower after haploidentical compared with matched unrelated donor transplants. Similar differences were observed after reduced intensity conditioning transplants, 19% vs 28% (P = .05) and 34% vs 52% (P = .002). Among patients receiving myeloablative regimens, 3-year probabilities of overall survival were 45% (95% CI, 36-54) and 50% (95% CI, 47-53) after haploidentical and matched unrelated donor transplants (P = .38). Corresponding rates after reduced intensity conditioning transplants were 46% (95% CI, 35-56) and 44% (95% CI, 0.40-47) (P = .71). Although statistical power is limited, these data suggests that survival for patients with AML after haploidentical transplantation with posttransplant cyclophosphamide is comparable with matched unrelated donor transplantation.

AB - We studied adults with acute myeloid leukemia (AML) after haploidentical (n = 192) and 8/8 HLA-matched unrelated donor (n = 1982) transplantation. Haploidentical recipients received calcineurin inhibitor (CNI), mycophenolate, and posttransplant cyclophosphamide for graft-versus-host disease (GVHD) prophylaxis; 104 patients received myeloablative and 88 received reduced intensity conditioning regimens. Matched unrelated donor transplant recipients received CNI with mycophenolate or methotrexate for GVHD prophylaxis; 1245 patients received myeloablative and 737 received reduced intensity conditioning regimens. In the myeloablative setting, day 30 neutrophil recovery was lower after haploidentical compared with matched unrelated donor transplants (90% vs 97%, P = .02). Corresponding rates after reduced intensity conditioning transplants were 93% and 96% (P = .25). In the myeloablative setting, 3-month acute grade 2-4 (16% vs 33%, P < .0001) and 3-year chronic GVHD (30% vs 53%, P < .0001) were lower after haploidentical compared with matched unrelated donor transplants. Similar differences were observed after reduced intensity conditioning transplants, 19% vs 28% (P = .05) and 34% vs 52% (P = .002). Among patients receiving myeloablative regimens, 3-year probabilities of overall survival were 45% (95% CI, 36-54) and 50% (95% CI, 47-53) after haploidentical and matched unrelated donor transplants (P = .38). Corresponding rates after reduced intensity conditioning transplants were 46% (95% CI, 35-56) and 44% (95% CI, 0.40-47) (P = .71). Although statistical power is limited, these data suggests that survival for patients with AML after haploidentical transplantation with posttransplant cyclophosphamide is comparable with matched unrelated donor transplantation.

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Haploidentical transplant with posttransplant cyclophosphamide vs matched unrelated donor transplant for acute myeloid leukemia

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