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 language | English (US) |
|---|---|
| Pages (from-to) | 1826-1836 |
| Number of pages | 11 |
| Journal | Blood Advances |
| Volume | 3 |
| Issue number | 12 |
| DOIs | |
| State | Published - Jan 1 2019 |
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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; Bolaños-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.; Kent Holland, H.; 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.
In: Blood Advances, Vol. 3, No. 12, 01.01.2019, p. 1826-1836.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Outcomes of haploidentical vs matched sibling transplantation for acute myeloid leukemia in first complete remission
AU - Rashidi, Armin
AU - Hamadani, Mehdi
AU - Zhang, Mei Jie
AU - Wang, Hai Lin
AU - Abdel-Azim, Hisham
AU - Aljurf, Mahmoud
AU - Assal, Amer
AU - Bajel, Ashish
AU - Bashey, Asad
AU - Battiwalla, Minoo
AU - Beitinjaneh, Amer M.
AU - Bejanyan, Nelli
AU - Bhatt, Vijaya Raj
AU - Bolaños-Meade, Javier
AU - Byrne, Michael
AU - Cahn, Jean Yves
AU - Cairo, Mitchell
AU - Ciurea, Stefan
AU - Copelan, Edward
AU - Cutler, Corey
AU - Daly, Andrew
AU - Diaz, Miguel Angel
AU - Farhadfar, Nosha
AU - Gale, Robert P.
AU - Ganguly, Siddhartha
AU - Grunwald, Michael R.
AU - Hahn, Theresa
AU - Hashmi, Shahrukh
AU - Hildebrandt, Gerhard C.
AU - Kent Holland, H.
AU - Hossain, Nasheed
AU - Kanakry, Christopher G.
AU - Kharfan-Dabaja, Mohamed A.
AU - Khera, Nandita
AU - Koc, Yener
AU - Lazarus, Hillard M.
AU - Lee, Jong Wook
AU - Maertens, Johan
AU - Martino, Rodrigo
AU - McGuirk, Joseph
AU - Munker, Reinhold
AU - Murthy, Hemant S.
AU - Nakamura, Ryotaro
AU - Nathan, Sunita
AU - Nishihori, Taiga
AU - Palmisiano, Neil
AU - Patel, Sagar
AU - Pidala, Joseph
AU - Olin, Rebecca
AU - Olsson, Richard F.
AU - Oran, Betul
AU - Ringden, Olov
AU - Rizzieri, David
AU - Rowe, Jacob
AU - Savoie, Mary Lynn
AU - Schultz, Kirk R.
AU - Seo, Sachiko
AU - Shaffer, Brian C.
AU - Singh, Anurag
AU - Solh, Melhem
AU - Stockerl-Goldstein, Keith
AU - Verdonck, Leo F.
AU - Wagner, John
AU - Waller, Edmund K.
AU - De Lima, Marcos
AU - Sandmaier, Brenda M.
AU - Litzow, Mark
AU - Weisdorf, Dan
AU - Romee, Rizwan
AU - Saber, Wael
PY - 2019/1/1
Y1 - 2019/1/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85068734856&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85068734856&partnerID=8YFLogxK
U2 - 10.1182/bloodadvances.2019000050
DO - 10.1182/bloodadvances.2019000050
M3 - Article
C2 - 31201170
AN - SCOPUS:85068734856
VL - 3
SP - 1826
EP - 1836
JO - Blood advances
JF - Blood advances
SN - 2473-9529
IS - 12
ER -