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Clinical Trial
. 2014 Dec;20(12):1975-81.
doi: 10.1016/j.bbmt.2014.08.013. Epub 2014 Sep 28.

Similar transplantation outcomes for acute myeloid leukemia and myelodysplastic syndrome patients with haploidentical versus 10/10 human leukocyte antigen-matched unrelated and related donors

Antonio Di Stasi  1 , Denái R Milton  2 , L M Poon  1 , Amir Hamdi  1 , Gabriela Rondon  1 , Julianne Chen  1 , Sai R Pingali  1 , Marina Konopleva  3 , Piyanuch Kongtim  1 , Amin Alousi  1 , Muzaffar H Qazilbash  1 , Sairah Ahmed  1 , Qaiser Bashir  1 , Gheath Al-atrash  1 , Betul Oran  1 , Chitra M Hosing  1 , Partow Kebriaei  1 , Uday Popat  1 , Elizabeth J Shpall  1 , Dean A Lee  4 , Marcos de Lima  5 , Katayoun Rezvani  1 , Issa F Khouri  1 , Richard E Champlin  1 , Stefan O Ciurea  6
Affiliations
Clinical Trial

Similar transplantation outcomes for acute myeloid leukemia and myelodysplastic syndrome patients with haploidentical versus 10/10 human leukocyte antigen-matched unrelated and related donors

Antonio Di Stasi et al. Biol Blood Marrow Transplant. 2014 Dec.

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 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 transplantation outcomes; however, there was a trend for improved outcomes in the MRD group, with 3-year progression-free survival for patients in remission of 57%, 45%, and 41% for MRD, MUD, and haploidentical recipients, respectively (P = .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 transplantation are warranted.

Keywords: Acute myeloid leukemia; Fludarabine-melphalan; Haploidentical transplantation; Hematopoietic stem cell transplantation; Myeloablative reduced-intensity conditioning regimen; Myelodysplastic syndromes; Post-transplantation cyclophosphamide.

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Conflict of interest statement

Disclosure of Conflicts of Interest: The authors have no conflict of interests to declare.

Figures

Figure 1
Figure 1. Transplant outcomes for recipients of haploidentical, matched related and 10/10 HLA matched unrelated donor transplants
(A) All treated patients and (B) patients in remission at transplant. Progression free survival (PFS), overall survival (OS) and cumulative incidence of non-relapse mortality are shown. C) Multivariable analysis for progression free survival for patients in remission prior to transplant, in relation to age, cytogenetic risk (SWOG), melphalan dose, donor type (matched vs. haploidentical), and HCT-CI.
Figure 2
Figure 2. Recovery of T cell subsets for recipients of haploidentical, matched siblings and 10/10 HLA matched unrelated donor transplants
Median number of T-lymphocyte subssets, B cells (CD20+) and Natural Killer cells (CD3negCD56+) are shown for each donor type (horizontal lines indicate reference values), and table displays range value.
See this image and copyright information in PMC

Comment in

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