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Comparative Study
. 2019 Jun 25;3(12):1826-1836.
doi: 10.1182/bloodadvances.2019000050.

Outcomes of haploidentical vs matched sibling transplantation for acute myeloid leukemia in first complete remission

Armin Rashidi  1 , Mehdi Hamadani  2 , Mei-Jie Zhang  2   3 , Hai-Lin Wang  2 , Hisham Abdel-Azim  4 , Mahmoud Aljurf  5 , Amer Assal  6 , Ashish Bajel  7 , Asad Bashey  8 , Minoo Battiwalla  9 , Amer M Beitinjaneh  10 , Nelli Bejanyan  11 , Vijaya Raj Bhatt  12 , Javier Bolaños-Meade  13 , Michael Byrne  14 , Jean-Yves Cahn  15 , Mitchell Cairo  16 , Stefan Ciurea  17 , Edward Copelan  18 , Corey Cutler  19 , Andrew Daly  20 , Miguel-Angel Diaz  21 , Nosha Farhadfar  22 , Robert P Gale  23 , Siddhartha Ganguly  24 , Michael R Grunwald  18 , Theresa Hahn  25 , Shahrukh Hashmi  5   26 , Gerhard C Hildebrandt  27 , H Kent Holland  8 , Nasheed Hossain  28 , Christopher G Kanakry  29 , Mohamed A Kharfan-Dabaja  30 , Nandita Khera  31 , Yener Koc  32 , Hillard M Lazarus  33 , Jong-Wook Lee  34 , Johan Maertens  35 , Rodrigo Martino  36 , Joseph McGuirk  24 , Reinhold Munker  37 , Hemant S Murthy  22 , Ryotaro Nakamura  38 , Sunita Nathan  39 , Taiga Nishihori  40 , Neil Palmisiano  41 , Sagar Patel  42 , Joseph Pidala  43 , Rebecca Olin  44 , Richard F Olsson  45   46 , Betul Oran  47 , Olov Ringden  48 , David Rizzieri  49 , Jacob Rowe  50 , Mary Lynn Savoie  20 , Kirk R Schultz  51 , Sachiko Seo  52 , Brian C Shaffer  53 , Anurag Singh  24 , Melhem Solh  8 , Keith Stockerl-Goldstein  54 , Leo F Verdonck  55 , John Wagner  41 , Edmund K Waller  56 , Marcos De Lima  57 , Brenda M Sandmaier  58 , Mark Litzow  59 , Dan Weisdorf  60 , Rizwan Romee  19 , Wael Saber  2
Affiliations
Comparative Study

Outcomes of haploidentical vs matched sibling transplantation for acute myeloid leukemia in first complete remission

Armin Rashidi et al. Blood Adv. .

Abstract

HLA-haploidentical hematopoietic cell transplantation (Haplo-HCT) using posttransplantation cyclophosphamide (PT-Cy) has improved donor availability. However, a matched sibling donor (MSD) is still considered the optimal donor. Using the Center for International Blood and Marrow Transplant Research database, we compared outcomes after Haplo-HCT vs MSD in patients with acute myeloid leukemia (AML) in first complete remission (CR1). Data from 1205 adult CR1 AML patients (2008-2015) were analyzed. A total of 336 patients underwent PT-Cy-based Haplo-HCT and 869 underwent MSD using calcineurin inhibitor-based graft-versus-host disease (GVHD) prophylaxis. The Haplo-HCT group included more reduced-intensity conditioning (65% vs 30%) and bone marrow grafts (62% vs 7%), consistent with current practice. In multivariable analysis, Haplo-HCT and MSD groups were not different with regard to overall survival (P = .15), leukemia-free survival (P = .50), nonrelapse mortality (P = .16), relapse (P = .90), or grade II-IV acute GVHD (P = .98). However, the Haplo-HCT group had a significantly lower rate of chronic GVHD (hazard ratio, 0.38; 95% confidence interval, 0.30-0.48; P < .001). Results of subgroup analyses by conditioning intensity and graft source suggested that the reduced incidence of chronic GVHD in Haplo-HCT is not limited to a specific graft source or conditioning intensity. Center effect and minimal residual disease-donor type interaction were not predictors of outcome. Our results indicate a lower rate of chronic GVHD after PT-Cy-based Haplo-HCT vs MSD using calcineurin inhibitor-based GVHD prophylaxis, but similar other outcomes, in patients with AML in CR1. Haplo-HCT is a viable alternative to MSD in these patients.

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Conflict of interest statement

Conflict-of-interest disclosure: The authors declare no competing financial interests.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Outcomes after Haplo-HCT vs MSD in patients with AML in CR1. Adjusted curves for OS (A), LFS (B), relapse (C), NRM (D), grade II-IV acute GVHD (E), and chronic GVHD (F).
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