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

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

Research output: Contribution to journalArticlepeer-review

26 Scopus 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 5 .15), leukemia-free survival (P 5 .50), nonrelapse mortality (P 5 .16), relapse (P 5 .90), or grade II-IV acute GVHD (P 5 .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.

Original languageEnglish (US)
Pages (from-to)1826-1836
Number of pages11
JournalBlood Advances
Volume3
Issue number12
DOIs
StatePublished - 2019

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