Stem cell transplantation from a haploidentical donor versus a genoidentical sister for adult male patients with acute myelogenous leukemia in first remission: A retrospective study from the acute leukemia working party of the European Society for Blood and Marrow Transplantation

Abstract

Background In adult patients with acute myeloid leukemia (AML), a matched sibling donor (MSD) is considered the first choice for an allogeneic transplantation. However, a female donor for a male recipient is a poor prognostic factor. The authors compared haploidentical (HAPLO) donors with female MSDs. Methods In total, 834 men underwent allogenic transplantation from a female MSD, and 232 men underwent allogenic transplantation from a HAPLO donor. Of these, 86% of HAPLO recipients and 3% of MSD recipients received graft‐versus‐host disease (GVHD) prophylaxis posttransplantation with high‐dose cyclophosphamide. A significant qualitative interaction was observed between donor type and cytogenetics, Therefore, the analyses were stratified on cytogenetics. Results Of the men with intermediate‐risk AML, 638 received transplantation from a female MSD, and 160 received transplantation from a HAPLO donor. In multivariate analysis, poor risk factors were a HAPLO donor versus an MSD for nonrelapse mortality (hazard ratio [HR], 1.7; P = .02) and patient age for nonrelapse mortality and overall survival (HR, 1.22 [P = .02] and 1.15 [P = .02], respectively). HAPLO transplantation resulted in less chronic GVHD (HR, 0.43; P < 10−4) but lower leukemia‐free survival (HR, 1.7; P = .04). The GVHD/relapse‐free survival (GRFS) was not different. Of the men with high‐risk AML, 196 received transplantation from a female MSD, and 72 received transplantation from a HAPLO donor. By multivariate analysis, HAPLO recipients had a lower incidence of relapse (HR, 0.40; P = .004), better leukemia‐free survival (HR, 0.46; P = .003), better overall survival (HR, 0.43; P = .003), and better GRFS (HR, 0.54; P = .006). Conclusions In men who have intermediate‐risk AML, allogenic transplantation from a sister MSD or a HAPLO donor produces similar GRFS. However, in men who have high‐risk AML, a HAPLO donor combined with prophylactic high‐dose cyclophosphamide posttransplantation may be a better choice.

Post-remission measurable residual disease directs treatment choice and improves outcomes for patients with intermediate-risk acute myeloid leukemia in CR1

“…Additionally, different outcomes were not found among the MSD, MUD, and HID transplant subgroups, although the sample sizes were limited. This agrees with results from recent studies, which have also indicated that clinical outcomes for HID are equivalent to MSD and MUD transplantation [ 39 – 42 ]. Therefore, consolidation chemotherapy and auto-HSCT could be considered a valuable alternative after induction therapy, which may be preferred for patients with IR-AML and MRD3 negativity in the absence of a suitably matched donor.…”

Improved survival for young acute leukemia patients following a new donor hierarchy for allogeneic hematopoietic stem cell transplantation: A phase III randomized controlled study

“…Data from our retrospective analysis showed that patients receiving HSCT from an MSD or HSD can achieve equivalent 5-year OS and DFS; however, after controlling for high-risk patients, a superior GVL effect was observed in high-risk patients undergoing HSD-HSCT with lower relapse and higher DFS rates compared to patients undergoing MSD-HSCTs. The priority use of T-cell-replete HID-HSCT with ATG or PT-Cy in high-risk patients has been reported by our group and other groups 1,23,36 ; however, according to our study no advantage of HID-HSCTs was observed in intermediate/standard-risk patients for HSDs or HPDs. However, it is also worth noting that the follow-up after the new donor selection strategy to our case is short and needs longer follow-up and a larger number and more homogeneous of patient population to confirm the efficiency of the new donor selection strategy.…”

“…A retrospective study from the EBMT involving 1066 male adult patients with de novo AML undergoing a first allo‐HSCT in CR1 using a female MSD or a T‐replete haploidentical male or female donor, suggested that in men with intermediate‐risk AML, allo‐HSCT from a sister MSD or a haploidentical donor produces similar GRFS. In men who have high‐risk AML, a haploidentical donor may be a better choice 23 . To date, there were four published studies involving donor options for old patients receiving allo‐HSCT.…”

“…In men who have highrisk AML, a haploidentical donor may be a better choice. 23 To date, there were four published studies involving donor options for old patients receiving allo-HSCT. Robinson et al 24 Advanced donor age has been shown to correlate with unfavorable transplant outcomes in URD-HSCTs 26,27 and HID-HSCTs.…”

Haploidentical Hematopoietic Stem Cell Transplantation Followed by ‘Post-Cyclophosphamide’: The Future of Allogeneic Stem Cell Transplant

“…GRFS survival was comparable. However, in high-risk AML patients, haploidentical recipients had lower rates of relapse as well as superior GRFS, LFS, and OS [ 65 ].…”