T‐cell–depleted haploidentical stem cell transplantation results improve with time in adults with acute leukemia: A study from the Acute Leukemia Working Party of the European Society of Blood and Marrow Transplantation (EBMT)

Sestili, Simona; Labopin, Myriam; Ruggeri, Annalisa; Velardi, Andrea; Ciceri, Fabio; Maertens, Johan; Kanz, Lothar; Aversa, Franco; Lewalle, Philippe; Bunjes, Donald; Mohty, Mohamad; Nagler, Arnon

doi:10.1002/cncr.31310

Cited by 9 publications

(9 citation statements)

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“…61, 62) compared with early T-cell-depleted haplo-HSCT procedures (30%-54%; refs. 21,26,33). Especially among patients ages 40-60 years, the rate of NRM did not increase with age following myeloablative conditioning, which is in accordance with our previous report that the outcomes of older patients (age > 50 years) were comparable with those of younger patients (63).…”

Section: Discussionsupporting

confidence: 90%

“…In addition, the impact of imbalanced patient characteristics, such as the lower median age in the haplo-HSCT cohort than in the chemotherapy group, likely affected the observed outcomes. Thus, whether the benefit of haplo-HSCT in individuals with heterogeneous AML can be replicated for those with int-risk AML remains controversial (31,33).…”

Section: Introductionmentioning

confidence: 99%

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Myeloablative Haploidentical Transplantation Is Superior to Chemotherapy for Patients with Intermediate-risk Acute Myelogenous Leukemia in First Complete Remission

Wang

Chang

et al. 2019

Clinical Cancer Research

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Purpose: Although myeloablative HLA haploidentical hematopoietic stem cell transplantation (haplo-HSCT) following pretransplant anti-thymocyte globulin (ATG) and granulocyte colony-stimulating factor (G-CSF) stimulated grafts (ATGþG-CSF) has been confirmed as an alternative to HSCT from HLA-matched sibling donors (MSD), the effect of haplo-HSCT on postremission treatment of patients with acute myeloid leukemia (AML) with intermediate risk (int-risk AML) who achieved first complete remission (CR1) has not been defined. Patients and Methods: In this prospective trial, among 443 consecutive patients ages 16-60 years with newly diagnosed de novo AML with int-risk cytogenetics, 147 patients with molecular int-risk AML who achieved CR1 within two courses of induction and remained in CR1 at 4 months postremission either received chemotherapy (n ¼ 69) or underwent haplo-HSCT (n ¼ 78). Results: The 3-year leukemia-free survival (LFS) and overall survival (OS) were significantly higher in the haplo-HSCT group than in the chemotherapy group (74.3% vs. 47.3%; P ¼ 0.0004 and 80.8% vs. 53.5%; P ¼ 0.0001, respectively). In the multivariate analysis with propensity score adjustment, postremission treatment (haplo-HSCT vs. chemotherapy) was an independent risk factor affecting the LFS [HR 0.360; 95% confidence interval (CI), 0.163-0.793; P ¼ 0.011], OS (HR 0.361; 95% CI, 0.156-0.832; P ¼ 0.017), and cumulative incidence of relapse (HR 0.161; 95% CI, 0.057-0.459; P ¼ 0.001) either in entire cohort or stratified by minimal residual disease after the second consolidation. Conclusions: Myeloablative haplo-HSCT with ATGþG-CSF is superior to chemotherapy as a postremission treatment in patients with int-risk AML during CR1. Haplo-HSCT might be a first-line postremission therapy for int-risk AML in the absence of HLA-MSDs. Haplo-HSCT might be superior to chemotherapy as a first-line postremission treatment of intermediate-risk AML in CR1.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Myeloablative Haploidentical Transplantation Is Superior to Chemotherapy for Patients with Intermediate-risk Acute Myelogenous Leukemia in First Complete Remission

Wang

Chang

et al. 2019

Clinical Cancer Research

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“…The advantages of a low CIR and an acceptable NRM resulted in promising results of haplo-SCT in the present study, which were comparable to those in previous reports (5year LFS 68.7%, OS 70.1%) [5,8]. As NRM of haplo-SCT has generally improved with either the PT-CY (7 to 23%) or ATG+G-CSF protocol (11-13%) compared with early procedures [4,9,10], NRM might no longer be a limiting factor of receiving haplo-SCT, especially in experienced centers. haplo-SCT was associated with lower CIR in both the Con-1 MRD +/− subgroups in the current study; meanwhile, cautions must be taken as CIR of non-SCT cohort might be higher compared with previous reports (46-49%) [1,2].…”

Section: To the Editorsupporting

confidence: 88%

Comparison of haplo-SCT and chemotherapy for young adults with standard-risk Ph-negative acute lymphoblastic leukemia in CR1

Jiang

Zhou

et al. 2020

J Hematol Oncol

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Human leukocyte antigen (HLA) haploidentical stem cell transplantation (haplo-SCT) as a postremission treatment for standard risk Philadelphia chromosome-negative acute lymphoblastic leukemia (SR Ph-ALL) in the first complete remission (CR1) has not been defined. In this multicenter, phase 3 study (NCT02042690), of the 131 consecutive Ph-ALL young adult patients (YA, aged 18-39 years) without high-risk features who achieved CR1, 114 patients without HLA-matched donors received consolidation with an adult chemotherapy regimen (n = 55) or haplo-SCT (n = 59). In the landmark analysis, haplo-SCT resulted in a lower 2-year cumulative incidence of relapse (CIR, 12.8% vs 46.7%, P = 0.0017) and superior 2-year leukemia-free survival (LFS, 80.9% vs 51.1%, P = 0.0116) and 2-year overall survival (OS, 91.2% vs 75.7 [64.8-93.2] %, P = 0.0408) than chemotherapy. In the time-dependent multivariate analysis with propensity score adjustment, postremission treatment (haplo-SCT vs chemotherapy) was an independent risk factor for the CIR (HR 0.195, 95% CI 0.076-0.499, P = 0.001), LFS (HR 0.297, 95% CI 0.131-0.675, P = 0.003), and OS (HR 0.346, 95% CI 0.140-0.853, P = 0.011). In all subgroups, CIR was lower in haplo-SCT. Myeloablative haplo-SCT with ATG+G-CSF might be one of the preferred therapies for YA patients with standard-risk Ph-ALL.

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“…Haplo-HSCT is an attractive treatment for patients with high-risk hematological malignancies lacking a well-matched unrelated donor and who require a HSCT urgently. Today, rejection and GvHD are no longer major issues and a recent registry-based study of the EBMT confirmed that outcomes of TCD haplo-HSCT have improved over time reflecting gaining experience, better selection of the donor-recipient pairs, evolution of the conditioning regimens, better supportive care, and treatment options for infections complications, that remain the main cause of death in this setting (84).…”

Section: Discussionmentioning

confidence: 99%

The Evolution of T Cell Depleted Haploidentical Transplantation

et al. 2019

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Work on bone marrow transplantation from haploidentical donor has been proceeding for over 20 years all over the world and new transplant procedures have been developed. To control both graft rejection and graft vs. host disease, some centers have preferred to enhance the intensity of the conditioning regimens and the post-transplant immune suppression in the absence of graft manipulation; others have concentrated on manipulating the graft in the absence of any additional post-transplant immune suppressive agent. Due to the current high engraftment rates, the low incidence of graft-vs.-host disease and regimen related mortality, transplantation from haploidentical donors have been progressively offered even to elderly patients. Overall, survivals compare favorably with reports on transplants from unrelated donors. Further improvements will come with successful implementation of strategies to enhance post-transplant immune reconstitution and to prevent leukemia relapse.

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T‐cell–depleted haploidentical stem cell transplantation results improve with time in adults with acute leukemia: A study from the Acute Leukemia Working Party of the European Society of Blood and Marrow Transplantation (EBMT)

Abstract: The outcome of patients with acute leukemia who underwent T-cell-depleted haplo has improved over time. Cancer 2018;124:2142-50. © 2018 American Cancer Society.

Cited by 9 publications

References 23 publications

Myeloablative Haploidentical Transplantation Is Superior to Chemotherapy for Patients with Intermediate-risk Acute Myelogenous Leukemia in First Complete Remission

Myeloablative Haploidentical Transplantation Is Superior to Chemotherapy for Patients with Intermediate-risk Acute Myelogenous Leukemia in First Complete Remission

Comparison of haplo-SCT and chemotherapy for young adults with standard-risk Ph-negative acute lymphoblastic leukemia in CR1

The Evolution of T Cell Depleted Haploidentical Transplantation

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