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. 2018 Aug 30;11(1):110.
doi: 10.1186/s13045-018-0655-8.

Haploidentical transplantation is associated with better overall survival when compared to single cord blood transplantation: an EBMT-Eurocord study of acute leukemia patients conditioned with thiotepa, busulfan, and fludarabine

Federica Giannotti  1 , Myriam Labopin  1   2 , Roni Shouval  3   4 , Jaime Sanz  5   6 , William Arcese  7 , Emanuele Angelucci  8 , Jorge Sierra  9 , Josep-Maria Ribera Santasusana  10 , Stella Santarone  11 , Bruno Benedetto  12 , Alessandro Rambaldi  13 , Riccardo Saccardi  14 , Didier Blaise  15 , Michele Angelo Carella  16 , Vanderson Rocha  17   18   19 , Frederic Baron  20 , Mohamad Mohty  1   2 , Annalisa Ruggeri  1   21 , Arnon Nagler  2   22
Affiliations

Haploidentical transplantation is associated with better overall survival when compared to single cord blood transplantation: an EBMT-Eurocord study of acute leukemia patients conditioned with thiotepa, busulfan, and fludarabine

Federica Giannotti et al. J Hematol Oncol. .

Abstract

Background: Thiotepa-busulfan-fludarabine (TBF) is a widely used conditioning regimen in single umbilical cord blood transplantation (SUCBT). More recently, it was introduced in the setting of non-T cell depleted haploidentical stem cell transplantation (NTD-Haplo). Whether TBF based conditioning provides additional benefit in transplantation from a particular alternative donor type remains to be established.

Methods: This was a retrospective study based on an international European registry. We compared outcomes of de-novo acute myeloid leukemia patients in complete remission receiving NTD-Haplo (n = 186) vs. SUCBT (n = 147) following myeloablative conditioning (MAC) with TBF. Median follow-up was 23 months. Treatment groups resembled in baseline characteristics.

Results: SUCBT was associated with delayed engraftment and higher graft failure. In multivariate analysis no statistically significant differences were observed between the two groups in terms of acute or chronic graft-versus-host disease (GvHD) (HR = 1.03, p = 0.92 or HR = 1.86, p = 0.21) and relapse incidence (HR = 0.8, p = 0.65). Non-relapse mortality (NRM) was significantly higher in SUCBT as compared to NTD-Haplo (HR = 2.63, p = 0.001); moreover, SUCBT did worse in terms of overall survival (HR = 2.18, p = 0.002), leukemia-free survival (HR = 1.94, p = 0.007), and GvHD relapse-free survival (HR = 2.38, p = 0.0002).

Conclusions: Our results suggest that TBF-MAC might allow for a potent graft-versus-leukemia, regardless of the alternative donor type. Furthermore, in patients receiving TBF-MAC, survival with NTD-Haplo may be better compared to SUCBT due to decreased NRM.

Keywords: Acute myeloid leukemia; Conditioning regimens; Haploidentical stem cell transplantation; Stem cell transplantation; Thiotepa-busulfan-fludarabine; Umbilical cord blood transplantation.

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Conflict of interest statement

Ethics approval and consent to participate

The Review Boards of the ALWP of EBMT and Eurocord approved this study.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
The cumulative incidence of relapse (a) and NRM (b) by donor type. The numbers of patients at risk for the event are included below each graph. Haploidentical transplantation (Haplo) and single umbilical cord blood transplantation (CBT)
Fig. 2
Fig. 2
The estimated probability of overall survival (a), leukemia-free survival (b), and GRFS (c) by donor type. The numbers of patients at risk for the event are included below each graph. Graft-versus-host disease-free relapse-free survival (GRFS), haploidentical transplantation (Haplo), and single umbilical cord blood transplantation (CBT)
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