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Comparative Study
. 2017 Jan 19;10(1):24.
doi: 10.1186/s13045-017-0394-2.

A comparison between allogeneic stem cell transplantation from unmanipulated haploidentical and unrelated donors in acute leukemia

Simona Piemontese  1   2 , F Ciceri  1   2 , M Labopin  2   3 , W Arcese  4 , S Kyrcz-Krzemien  5 , S Santarone  6 , H Huang  7 , D Beelen  8 , N C Gorin  2   3 , C Craddock  9 , Z Gulbas  10 , A Bacigalupo  11 , M Mohty  2   3 , A Nagler  2   12 ; Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT)
Affiliations
Comparative Study

A comparison between allogeneic stem cell transplantation from unmanipulated haploidentical and unrelated donors in acute leukemia

Simona Piemontese et al. J Hematol Oncol. .

Abstract

Background: In the absence of a HLA-matched related or matched unrelated donor, allogeneic stem cell transplantation (allo-SCT) from mismatched unrelated donors or haploidentical donors are potential alternatives for patients with acute leukemia with an indication to allo-SCT. The objective of this study was to compare the outcome of allo-SCT from T cell-replete haploidentical (Haplo) versus matched (MUD 10/10) or mismatched unrelated donor at a single HLA-locus (MMUD 9/10) for patients with acute leukemia in remission.

Methods: Two hundred sixty-five adult patients with de novo acute leukemia in first or second remission that received a Haplo-SCT between January 2007 and December 2013 were compared with 2490 patients receiving a MUD 10/10 and 813 receiving a MMUD 9/10. Propensity score weighted analysis was conducted in order to control for disease risk imbalances between the groups.

Results: The weighted 3-year non-relapse mortality and relapse incidence were 29 and 30% for Haplo, 21 and 29% for MUD 10/10, and 29 and 25% for MMUD 9/10, respectively. The weighted 3-year leukemia-free survival (LFS) and overall survival (OS) were 41 and 46% for Haplo, 50 and 56% for MUD 10/10, and 46 and 48% for MMUD 9/10, respectively. Using weighted Cox model, both LFS and OS were significantly higher in transplants from MUD 10/10 compared from those in Haplo but not different between transplants from MMUD 9/10 and Haplo. The type of donor was not significantly associated with neither acute nor chronic graft-versus-host disease.

Conclusions: Patients with acute leukemia in remission have better outcomes if transplanted from a MUD 10/10. We did not find any significant difference in outcome between transplants from MMUD 9/10 and Haplo, suggesting that both can be equally used in the absence of a 10/10 MUD. KEY POINT 1: Better outcomes using fully (10/10) matched unrelated donor for allo-SCT in acute leukemia in remission. KEY POINT 2: Similar outcomes after allo-SCT from unmanipulated haploidentical graft or mismatched (9/10) unrelated donor in acute leukemia in remission.

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Figures

Fig. 1
Fig. 1
Weighted CI of relapse and non-relapse mortality according to donor type. a Weighted CI of relapse. b Weighted CI of NRM
Fig. 2
Fig. 2
Weighted probability of leukemia-free survival and overall survival according to donor type. a Weighted probability of leukemia-free survival. b Weighted probability of overall survival
See this image and copyright information in PMC

References

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