Similar Transplantation Outcomes for Acute Myeloid Leukemia and Myelodysplastic Syndrome Patients with Haploidentical versus 10/10 Human Leukocyte Antigen–Matched Unrelated and Related Donors

Abstract

Allogeneic stem-cell transplantation for patients with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) has been performed primarily with an HLA matched donor. Outcomes of haploidentical transplantation have recently improved, and a comparison between these donor sources in a uniform cohort of patients has not been performed. We evaluated outcomes of 227 patients with AML/MDS treated with melphalan-based conditioning. Donors were matched related (MRD) (N=87, 38%), matched unrelated (MUD) (N=108, 48%), or haploidentical (N=32, 14%). No significant differences were found between haploidentical and MUD transplant outcomes; however, there was a trend for improved outcomes in the MRD group with a 3-year progression-free survival for patients in remission of 57%, 45% and 41% for MRD, MUD and haploidentical, respectively (P=0.417). Recovery of T-cell subsets was similar for all groups. These results suggest that haploidentical donors can safely extend transplantation for AML/MDS patients without an HLA matched donor. Prospective studies comparing haploidentical and MUD transplants are warranted.

Phase I trials using Sleeping Beauty to generate CD19-specific CAR T cells

“…Furthermore, only 2 of 10 recipients who underwent HLAmatched sibling donor HSCT and 2 of 9 patients who received haploidentical or mismatched family donor transplants developed reactivation of CMV after receiving CAR T cells. These data compare favorably with our reported CMV reactivation rates of 41% following matched-sibling (44) and 71% following haploidentical HSCT (53), suggesting that CAR T cells may help with immune reconstitution. Furthermore, in contrast with the expected rate of 50% GVHD noted after traditional donor lymphocyte infusion (54), we observed a lower rate of acute GVHD (11%).…”

T-replete haploidentical allogeneic transplantation using post-transplantation cyclophosphamide in advanced AML and myelodysplastic syndromes

“…The others series reporting the results of PT-Cy Haplo-SCT in the specific fields of AML or MDS included few patients (18)(19)(20)(21)(22)(23)(24)(25), with various proportion of refractory diseases (36-100%). [25][26][27] They found a PFS ranging from 39 to 72%. More recently, Bacigalupo et al reported promising results in AML and MDS, especially when Haplo-SCT was performed in CR1.…”

First Successful Haploidentical Stem Cell Transplantation in Romania

“…MSD, MUDs and haploSCT cases had similar grade II-IV acute GVHD (24%, 19%, and 26%) for the ones in remission, whereas severe acute GVHD was reported to be of 4%, 4% and respectively 0%. PFS at 3 years was concluded to be similar (57%, 45%, and 41%) but a significant trend towards a better 3-year progression-free survival was reported in those with a matched sibling donor [22]. Thus, almost identical results are between haploSCT transplants and the matched ones, for both lymphoid and myeloid malignancies, mostly due to various conditioning chemotherapy regimens.…”