Related haploidentical donors are a better choice than matched unrelated donors: Counterpoint

Shaw, Bronwen E.

doi:10.1182/bloodadvances.2016002188

Cited by 16 publications

(15 citation statements)

References 57 publications

(28 reference statements)

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“…Nevertheless, NRM remained high at .40%, regardless of the type of GVHD prophylaxis used, and chronic GVHD was still quite frequent, involving ;30% of patients, which is in the higher range according to a recent review. 17,18 Of note, the main cause of NRM was infection, which occurred in patients without active GVHD at the time of death. This issue has been rarely highlighted, but immune defects after haplo transplantation might be profound, and immune recovery is usually delayed as compared with HLA-matched transplantation.…”

Section: Discussionmentioning

confidence: 99%

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Haploidentical transplant in patients with myelodysplastic syndrome

et al. 2017

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Key Points• Nonrelapse mortality remains high in MDS patients who underwent haploidentical transplant before 2015.• Haplotransplantation using PT-CY and reduced-intensity conditioning seems an acceptable option in MDS patients lacking HLA-matched donors. Eighty-four (37%) patients had MDS transformed into acute myeloid leukemia at the time of transplant. Ex vivo T-cell depletion was used in 34 patients. One hundred ninety-four patients received a T-cell replete transplant and 102 patients received posttransplant cyclophosphamide (PT-CY) as graft-versus-host disease (GVHD) prophylaxis. The cumulative incidences of acute and chronic GVHD in PT-CY vs other patients were 25% vs 37% and 37% vs 24%, respectively. The cumulative incidence of nonrelapse mortality was 55% in patients who did not receive PT-CY (no PT-CY) and 41% in patients who did receive PT-CY.Three-year overall survival was 28% in no PT-CY patients and 38% in PT-CY patients. In multivariable analysis, the main risk factors were the intensity of the conditioning regimen and the use of PT-CY. In conclusion, the outcomes of MDS patients who received an haploidentical transplant are close to the results other transplantations from HLAmismatched donors with approximately one-third of patients alive and free of disease 3 years after transplant, and the use of PT-CY may improve their outcomes.

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Section: Discussionmentioning

confidence: 99%

“…Of note, GVHD was a rare cause of death in PT-CY (4% of all death causes). The cumulative incidence for NRM was 49% (95% CI, 41-56) at 3 years, whereas the relapse rate was 22% (95% CI, [16][17][18][19][20][21][22][23][24][25][26][27][28] …”

Section: Outcomementioning

confidence: 99%

Haploidentical transplant in patients with myelodysplastic syndrome

et al. 2017

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“…Interestingly, 4 years later, now in 2019, that difficult decision remains far from settled. Top leaders in the field recognise that, despite some clear advantages and disadvantages for the various options available, we still do not to know which should be the best alternative to MSD for most patients, in a debate that remains open to this date [14][15][16][17]. Some groups would suggest that some MMAD should be preferred for particular indications, such as for instance CB for high-risk acute myeloid leukaemia (AML) with minimal residual disease detectable at the time of HSCT [18].…”

Section: Donor Categories and Stem Cell Sourcesmentioning

confidence: 99%

Indications for haematopoietic stem cell transplantation for haematological diseases, solid tumours and immune disorders: current practice in Europe, 2019

Duarte

Labopin

Bader

et al. 2019

Bone Marrow Transplant

240

172

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This is the seventh special EBMT report on the indications for haematopoietic stem cell transplantation for haematological diseases, solid tumours and immune disorders. Our aim is to provide general guidance on transplant indications according to prevailing clinical practice in EBMT countries and centres. In order to inform patient decisions, these recommendations must be considered together with the risk of the disease, the risk of the transplant procedure and the results of non-transplant strategies. In over two decades since the first report, the EBMT indications manuscripts have incorporated changes in transplant practice coming from scientific and technical developments in the field. In this same period, the establishment of JACIE accreditation has promoted high quality and led to improved outcomes of patient and donor care and laboratory performance in transplantation and cellular therapy. An updated report with operating definitions, revised indications and an additional set of data with overall survival at 1 year and non-relapse mortality at day 100 after transplant in the commonest standard-of-care indications is presented. Additional efforts are currently underway to enable EBMT member centres to benchmark their risk-adapted outcomes as part of the Registry upgrade Project 2020 against national and/or international outcome data.

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“…While URD, haploidentical and UCB transplantation may lead to similar clinical outcomes, waiting times to transplantation vary significantly between graft sources. In fact, delays associated to URD search have been cited among the reasons that may justify the preferential use of other alternative donors [22]. Yet, potential differences in failure rates to reach transplantation by donor type assignment have not been taken into consideration in previous analyses.…”

Section: Discussionmentioning

confidence: 99%

Allocation to Matched Related or Unrelated Donor Results in Similar Clinical Outcomes without Increased Risk of Failure to Proceed to Transplant among Patients with Acute Myeloid Leukemia: A Retrospective Analysis from the Time of Transplant Approval

Rodríguez-Arbolí

Márquez-Malaver

Rodríguez-Torres

et al. 2019

Biology of Blood and Marrow Transplantation

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Clinical outcomes after allogeneic hematopoietic stem cell transplantation (allo-SCT) from unrelated donors (URDs) approach those of matched related donor (MRD) transplants in patients with acute myeloid leukemia (AML). Yet, available data fail to account for differences in pretransplantation outcomes between these donor selection strategies. In this regard, URD allo-HSCT is associated with longer waiting times to transplantation, potentially resulting in higher probabilities of failure to reach transplant. We retrospectively analyzed 108 AML patients accepted for first allo-HSCT from the time of approval to proceed to transplant. Fifty-eight (54%) patients were initially allocated to MRD, while URD search was initiated in 50 (46%) patients. Time to transplant was longer in patients allocated to a URD when compared with patients assigned to an MRD (median 142 days versus 100 days; p < .001). Forty-three of 58 (74%) patients in the MRD group and 35 of 50 (70%) patients in the URD group underwent transplantation (odds ratio [OR], 1.22; p = .63). Advanced disease status at the time of allo-HSCT approval was the only predictor of failure to reach transplantation in the multivariate analysis (OR, 4.78; p = .001). Disease progression was the most common cause of failure to reach allo-HSCT (66.7%) in both the MRD and URD groups. With a median follow-up from transplantation of 14.5 (interquartile range, 5 to 29) months, the 2-year estimate of overall survival (OS) from allo-HSCT was 46% in the MRD group and 57% in the URD group (p = .54). There were no differences in OS according to donor type allocation in the multivariate analysis (hazard ratio, 1.01; p = .83). When including patients from the time of transplant approval, 2-year OS was 39% in the MRD group versus 42% in the URD group. Our study suggests that allocation of AML patients to URDs may result in comparable clinical outcomes to MRD assignment without a significant increase in the risk of failure to reach transplant.

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Related haploidentical donors are a better choice than matched unrelated donors: Counterpoint

Cited by 16 publications

References 57 publications

Haploidentical transplant in patients with myelodysplastic syndrome

Haploidentical transplant in patients with myelodysplastic syndrome

Indications for haematopoietic stem cell transplantation for haematological diseases, solid tumours and immune disorders: current practice in Europe, 2019

Allocation to Matched Related or Unrelated Donor Results in Similar Clinical Outcomes without Increased Risk of Failure to Proceed to Transplant among Patients with Acute Myeloid Leukemia: A Retrospective Analysis from the Time of Transplant Approval

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