Haploidentical versus unrelated allogeneic stem cell transplantation for relapsed/refractory acute myeloid leukemia: a report on 1578 patients from the Acute Leukemia Working Party of the EBMT
Eolia Brissot,
Myriam Labopin,
Gerhard Ehninger,
Matthias Stelljes,
Arne Brecht,
Arnold Ganser,
Johanna Tischer,
Nicolaus Kröger,
Boris Afanasyev,
Jürgen Finke,
Ahmet Elmaagacli,
Herman Einsele,
Mohamad Mohty,
Arnon Nagler
Affiliations
Eolia Brissot
Service d’Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, APHP, Paris, France
Myriam Labopin
Service d’Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, APHP, Paris, France;Acute Leukemia Working Party office, Hôpital Saint Antoine, APHP, Paris, France
Gerhard Ehninger
Universitaetsklinikum Dresden, Medizinische Klinik und Poliklinik I, Germany
Matthias Stelljes
University of Münster, Department of Medicine A / Hematology and Oncology, Germany
Arne Brecht
Deutsche Klinik für Diagnostik, KMT Zentrum, Wiesbaden, Germany
Arnold Ganser
Hannover Medical School, Department of Haematology, Hemostasis, Oncology, and Stem Cell Transplantation, Germany
Johanna Tischer
Klinikum Grosshadern, Med. Klinik III, Munich, Germany
Nicolaus Kröger
University Hospital Eppendorf, Bone Marrow Transplantation Centre, Hamburg, Germany
Boris Afanasyev
First State Pavlov Medical University of St. Petersburg, Raisa Gorbacheva Memorial Research Institute for Pediatric Oncology, Hematology, and Transplantation, Russia
Jürgen Finke
University of Freiburg, Faculty of Medicine and Department of Medicine -Hematology, Oncology and Stem Cell Transplantation, Germany
Ahmet Elmaagacli
Asklepios Klinik St. Georg, Department of Hematology, Hamburg, Germany
Herman Einsele
Universitaetsklinikum Würzburg, Med. Klinik und Poliklinik II, Germany
Mohamad Mohty
Service d’Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, APHP, Paris, France;Acute Leukemia Working Party office, Hôpital Saint Antoine, APHP, Paris, France
Arnon Nagler
Acute Leukemia Working Party office, Hôpital Saint Antoine, APHP, Paris, France;Hematology Division, Chaim Sheba Medical Center and Tel Aviv University, Tel-Hashomer, Ramat-Gan, Israel
Primary refractory or relapsed acute myeloid leukemia is associated with a dismal prognosis. Allogeneic stem cell transplantation is the only therapeutic option that offers prolonged survival and cure in this setting. In the absence of a matched sibling donor, transplantation from unrelated 10/10 HLA allele-matched or 9/10 HLA allele-mismatched donors and haploidentical donors are potential alternatives. The current study aimed to compare the outcomes of acute myeloid leukemia patients with active disease who received allogeneic stem cell transplantation from a haploidentical donor with post-transplant cyclophosphamide (n=199) versus an unrelated 10/10-matched donor (n=1111) and versus an unrelated 9/10-mismatched donor (n=383) between 2007 and 2014 and who were reported to the European Society for Blood and Marrow Transplantation registry. Propensity score weighted analysis was conducted in order to control for disease risk imbalances between the groups. The leukemia-free survival rates at 2 years of recipients of grafts from a haploidentical donor, an unrelated 10/10-matched donor and an unrelated 9/10-mismatched donor were 22.8%, 28% and 22.2%, respectively (P=NS). In multivariate analysis, there were no significant differences in leukemia-free survival, overall survival, relapse incidence, non-relapse mortality, or graft-versus-host-disease-free relapse-free survival between the three groups. Two predictive factors were associated with a higher relapse incidence: transplantation during first or second relapse compared to primary refractory acute myeloid leukemia and poor cytogenetics. Allogeneic stem cell transplantation may rescue about 25% of acute myeloid leukemia patients with active disease. Importantly, the outcomes of transplants from haploidentical donors were comparable to those from 10/10-matched and 9/10-mismatched unrelated donors. Therefore, a haploidentical donor is a valid option for acute myeloid leukemia patients with active disease.
