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. 2016 Mar 15:9:25.
doi: 10.1186/s13045-016-0248-3.

Impact of conditioning intensity in T-replete haplo-identical stem cell transplantation for acute leukemia: a report from the acute leukemia working party of the EBMT

Marie T Rubio  1   2   3   4 , Bipin N Savani  5   6 , Myriam Labopin  7   8   9   5   10 , Simona Piemontese  5   11 , Emmanuelle Polge  7   8   9   5   10 , Fabio Ciceri  11 , Andrea Bacigalupo  12 , William Arcese  13 , Yener Koc  14 , Dietrich Beelen  15 , Zafer Gülbas  16 , Depei Wu  17 , Stella Santarone  18 , Johanna Tischer  19 , Boris Afanasyev  20 , Christoph Schmid  21 , Sebastian Giebel  22 , Mohamad Mohty  7   8   9   5   10 , Arnon Nagler  9   23
Affiliations

Impact of conditioning intensity in T-replete haplo-identical stem cell transplantation for acute leukemia: a report from the acute leukemia working party of the EBMT

Marie T Rubio et al. J Hematol Oncol. .

Abstract

Background: Increasing numbers of patients are receiving haplo-identical stem cell transplantation (haplo-SCT) for treatment of acute leukemia with reduced intensity (RIC) or myeloablative (MAC) conditioning regimens. The impact of conditioning intensity in haplo-SCT is unknown.

Methods: We performed a retrospective registry-based study comparing outcomes after T-replete haplo-SCT for patients with acute myeloid (AML) or lymphoid leukemia (ALL) after RIC (n = 271) and MAC (n = 425). Regimens were classified as MAC or RIC based on published criteria.

Results: A combination of post-transplant cyclophosphamide (PT-Cy) with one calcineurin inhibitor and mycophenolate mofetil (PT-Cy-based regimen) for graft-versus-host disease (GVHD) prophylaxis was used in 66 (25%) patients in RIC and 125 (32%) in MAC groups. Patients of RIC group were older and had been transplanted more recently and more frequently for AML with active disease at transplant. Percentage of engraftment (90 vs. 92%; p = 0.58) and day 100 grade II to IV acute GVHD (24 vs. 29%, p = 0.23) were not different between RIC and MAC groups. Multivariable analyses, run separately in AML and ALL, showed a trend toward higher relapse incidence with RIC in comparison to MAC in AML (hazard ratio (HR) 1.34, p = 0.09), and no difference in both AML and ALL in terms of non-relapse mortality (NRM) chronic GVHD and leukemia-free survival. There was no impact of conditioning regimen intensity in overall survival (OS) in AML (HR = 0.97, p = 0.79) but a trend for worse OS with RIC in ALL (HR = 1.44, p = 0.10). The main factor impacting outcomes was disease status at transplantation (HR ≥ 1.4, p ≤ 0.01). GVHD prophylaxis with PT-Cy-based regimen was independently associated with reduced NRM (HR 0.63, p = 0.02) without impact on relapse incidence (HR 0.99, p = 0.94).

Conclusions: These data suggest that T-replete haplo-SCT with both RIC and MAC, in particular associated with PT-Cy, are valid options in first line treatment of high risk AML or ALL.

Keywords: Acute Leukemia; Allogeneic stem cell transplantation; Anti-leukemic effect; Conditioning regimen; Haplo-identical donor; Toxicity.

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Figures

Fig. 1
Fig. 1
Probability of (1a) relapse incidence (RI); (1b) non-relapse mortality (NRM); (1c) leukemia-free survival; and (1d) overall survival (OS) after MAC or RIC haplo-SCT for AL in CR1
Fig. 2
Fig. 2
Probability of overall survival (OS) after MAC or RIC haplo-SCT for AL in (2a) ≥ CR2 and (2b) with active disease at transplant
Fig. 3
Fig. 3
Probability of (3a) relapse incidence (RI); (3b) non-relapse mortality (NRM); (3c) LFS, and (3d) OS after haplo-SCT for AL with or without PT-Cy + CsA/Tacro + MMF as GVHD prophylaxis
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References

    1. Beatty PG, Clift RA, Mickelson EM, Nisperos BB, Flournoy N, Martin PJ, et al. Marrow transplantation from related donors other than HLA-identical siblings. N Engl J Med. 1985;313(13):765–71. - PubMed
    1. Anasetti C, Amos D, Beatty PG, Appelbaum FR, Bensinger W, Buckner CD, et al. Effect of HLA compatibility on engraftment of bone marrow transplants in patients with leukemia or lymphoma. N Engl J Med. 1989;320(4):197–204. doi: 10.1056/NEJM198901263200401. - DOI - PubMed
    1. Anasetti C, Beatty PG, Storb R, Martin PJ, Mori M, Sanders JE, et al. Effect of HLA incompatibility on graft-versus-host disease, relapse, and survival after marrow transplantation for patients with leukemia or lymphoma. Hum Immunol. 1990;29(2):79–91. doi: 10.1016/0198-8859(90)90071-V. - DOI - PubMed
    1. Kanda Y, Chiba S, Hirai H, Sakamaki H, Iseki T, Kodera Y, et al. Allogeneic hematopoietic stem cell transplantation from family members other than HLA-identical siblings over the last decade (1991-2000) Blood. 2003;102(4):1541–7. doi: 10.1182/blood-2003-02-0430. - DOI - PubMed
    1. Aversa F, Tabilio A, Velardi A, Cunningham I, Terenzi A, Falzetti F, et al. Treatment of high-risk acute leukemia with T-cell-depleted stem cells from related donors with one fully mismatched HLA haplotype. N Engl J Med. 1998;339(17):1186–93. doi: 10.1056/NEJM199810223391702. - DOI - PubMed

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