Human leukocyte antigen‐haploidentical transplantation for relapsed/refractory acute myeloid leukemia: Better leukemia‐free survival with bone marrow than with peripheral blood stem cells in patients ≥55 years of age

Baron, Frédéric; Labopin, Myriam; Tischer, Johanna; Ciceri, Fabio; Raiola, Anna Maria; Blaise, Didier; Sica, Simona; Vydra, Jan; Fanin, Renato; Stölzel, Friedrich; Busca, Alessandro; Díez-Martin, José L.; Koç, Yener; Nagler, Arnon; Mohty, Mohamad

doi:10.1002/ajh.26627

Cited by 6 publications

(5 citation statements)

References 46 publications

(74 reference statements)

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“…Indeed, Bashey et al observed lower relapse incidence with peripheral blood stem cells than with bone marrow after Haplo transplantation with post-transplant cyclophosphamide in a large registry study [36]. However, we could not confirm these findings in a large cohort of patients with active AML at transplantation [39]. Post-transplant maintenance therapies with FLT3 tyrosine-kinase inhibitors in case of FLT3-ITD AML [42], hypomethylating agents [43,44] or pre-emptive DLI [45][46][47] should be investigated in this group of patients.…”

Section: Discussioncontrasting

confidence: 62%

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Comparison of HLA-mismatched unrelated donor transplantation with post-transplant cyclophosphamide versus HLA-haploidentical transplantation in patients with active acute myeloid leukemia

Baron

Labopin

Tischer

et al. 2022

Bone Marrow Transplant

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HLA-haploidentical allogeneic hematopoietic stem cell transplantation (Haplo-HCT) is frequently used as treatment for patients with active acute myeloid leukemia (AML). Here, we investigated whether 9/10 HLA-mismatched unrelated donor transplantation (MMUD-HCT) with post-transplant cyclophosphamide (PTCy) is an adequate alternative. Inclusion criteria in this retrospective registry study consisted of adult patients, first HCT with a Haplo donor or MMUD between 2010 and 2020 using PTCy as graftversus-host disease (GVHD) prophylaxis, and primary refractory or relapsed disease. MMUD patients were pair-matched 1 to 2 with Haplo-recipients. A total of 73 MMUD patients met the inclusion criteria. Their data were compared to those of 146 Haplo patients in a matched-pair analysis. Median follow-up was 27 months in MMUD patients and 36 months in Haplo recipients. Two-year incidences of relapse and non-relapse mortality (NRM) were 40% and 18% in MMUD patients, respectively, versus 50% (P = 0.23) and 24% (P = 0.18) in Haplo recipients. Two-year leukemia-free survival (LFS) and overall survival (OS) was 42% and 46% in MMUD recipients, respectively, versus 26% (P = 0.1) and 28% (P = 0.061) in Haplo-patients. In conclusions, in AML patients with active disease at transplantation, MMUD-HCT results in at least comparable outcomes to Haplo-HCT when PTCy is applied.

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Section: Discussioncontrasting

confidence: 62%

“…Also, there was a higher proportion of patients given bone marrow stem cells in the Haplo group. Indeed, bone marrow has been associated with a lower incidence of GVHD than peripheral blood stem cells in the Haplo setting [35][36][37][38][39].…”

Section: Discussionmentioning

confidence: 99%

Comparison of HLA-mismatched unrelated donor transplantation with post-transplant cyclophosphamide versus HLA-haploidentical transplantation in patients with active acute myeloid leukemia

Baron

Labopin

Tischer

et al. 2022

Bone Marrow Transplant

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“…3 , 4 , 5 While the association of a calcineurin inhibitor and an antimetabolite with or without anti-thymocyte globulins (ATG) has remained the standard GVHD prophylaxis in the last decades, 6 , 7 post-transplant administration of cyclophosphamide (PTCy) has proven to be an efficient way to prevent GVHD, not only in the HLA-haploidentical allo-HCT setting but also in HLA-matched or 1/10 HLA-mismatched allo-HCT. 8 , 9 , 10 , 11 , 12 However, the precise mechanisms of GVHD prevention by PTCy (and particularly the potential role of regulatory T cells (Treg)) remains debated.…”

Section: Introductionmentioning

confidence: 99%

Post-transplant cyclophosphamide prevents xenogeneic graft-versus-host disease while depleting proliferating regulatory T cells

Ritacco¹,

Köse²,

Courtois³

et al. 2023

iScience

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“…Post-transplant cyclophosphamide (PTCy)-based GVHD prophylaxis has revolutionized the field of human leukocyte antigen (HLA)-haploidentical hematopoietic cell transplantation (Haplo-HCT) [ 5 , 6 ]. Consequently, Haplo-HCT is nowadays frequently used as treatment for relapsed/refractory AML patients [ 7 ]. A recent systems biology analysis in patients with PTCy-based GVHD prophylaxis demonstrated different signatures associated with GVHD and GvL effects [ 8 ].…”

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confidence: 99%

GVHD occurrence does not reduce AML relapse following PTCy-based haploidentical transplantation: a study from the ALWP of the EBMT

et al. 2023

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The association between graft-versus-host disease (GVHD) occurrence and acute myeloid leukemia (AML) relapse in patients treated with HLA-haploidentical allogeneic hematopoietic stem cell transplantation (Haplo-HCT) with post-transplant cyclophosphamide (PTCy)-based GVHD prophylaxis has remained debated. Here, we addressed this issue in patients with active AML at transplantation. 2-year cumulative incidences of relapse and leukemia-free survival (LFS) were 49% and 32.3%, respectively. There were no associations between acute nor chronic GVHD of any grade and lower relapse incidence. However, grade I acute GVHD was associated with better LFS (HR = 0.71, 95% CI 0.51–0.99, P = 0.04). In contrast, grade III–IV acute (HR = 3.09, 95% CI 1.87–5.12, P < 0.0001) as well as extensive chronic (HR = 3.3, 95% CI 1.81–6.04, P = 0.0001) GVHD correlated with higher nonrelapse mortality leading to lower LFS (HR = 1.36, 95% CI 0.99–1.86, P = 0.056 and HR = 1.97, 95% CI 1.35–2.89, P = 0.0004, respectively). In conclusion, these data suggest a dissociation of graft-versus-leukemia effects from GVHD in patients with active AML treated with PTCy-based Haplo-HCT.

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Human leukocyte antigen‐haploidentical transplantation for relapsed/refractory acute myeloid leukemia: Better leukemia‐free survival with bone marrow than with peripheral blood stem cells in patients ≥55 years of age

Cited by 6 publications

References 46 publications

Comparison of HLA-mismatched unrelated donor transplantation with post-transplant cyclophosphamide versus HLA-haploidentical transplantation in patients with active acute myeloid leukemia

Comparison of HLA-mismatched unrelated donor transplantation with post-transplant cyclophosphamide versus HLA-haploidentical transplantation in patients with active acute myeloid leukemia

Post-transplant cyclophosphamide prevents xenogeneic graft-versus-host disease while depleting proliferating regulatory T cells

GVHD occurrence does not reduce AML relapse following PTCy-based haploidentical transplantation: a study from the ALWP of the EBMT

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