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. 2023 Dec;12(6):255-267.
doi: 10.14740/jh1162. Epub 2023 Dec 28.

Haploidentical and Matched Sibling Transplantation for Acute Myeloid Leukemia: A Hospital-Based Study

Juan C Baena  1   2 , Maria C Rosales  1 , Mayra Estacio  3 , Alejandra Hidalgo  3 , Elizabeth Arrieta  2   4 , Francisco J Jaramillo  2   4 , Eliana Manzi  3 , Luis Gabriel Parra-Lara  1   3 , Joaquin D Rosales  2   4
Affiliations

Haploidentical and Matched Sibling Transplantation for Acute Myeloid Leukemia: A Hospital-Based Study

Juan C Baena et al. J Hematol. 2023 Dec.

Abstract

Background: Allogeneic peripheral blood stem cell transplantation (PBSCT) has been increasing for the last years in Latin America. The objective of this study was to describe clinical outcomes in acute myeloid leukemia (AML) receiving allogeneic PBSCT between 2013 and 2019 in a single center of Cali, Colombia.

Methods: A retrospective cohort study was conducted in Fundacion Valle del Lili. Patients diagnosed with AML who received an allogeneic PBSCT between 2013 and 2019 using human leukocyte antigen (HLA)-matched sibling donors (MSDs) or haploidentical related donors (HRDs) with myeloablative conditioning regimen were included. Cases with diagnosis of promyelocytic leukemia, myelodysplastic syndrome-related AML and therapy-related AML were excluded. Data were obtained directly from the hospital PBSCT database and clinical records.

Results: A total of 50 patients were included (HRD, n = 32; MSD, n = 18). Sixty-two percent was in the first complete remission (CR1) at the time of the transplant, of which 26% were MSD and 74% were HRD. The European Group for Blood and Marrow Transplantation (EBMT) risk score was: 44% vs. 50% low, 28% vs. 28% intermediate and 28% vs. 22% high for MSD vs. HRD, respectively. Overall survival at 5 years for MSD was 62% (95% confidence interval (CI): 31-83%) and 43% (95% CI: 25-60%) for HRD. Event-free survival was 56% (95% CI: 26-78%) and 35.6% (95% CI: 18-53%), respectively. Non-relapse mortality at day-100 was 6% (95% CI: 0.8-35%) and 20% (95% CI: 9-39%). Relapse at5 years was 18% (95% CI: 4-58%) and 25% (95% CI: 10-52%). Overall mortality rate was 46%. The grade II-IV, III-IV acute graft-versus-host disease and severe chronic graft-versus-host disease was 44%, 11% and 12% for MSD, and 43%, 9% and 0% for HRD.

Conclusion: These results underline that MSD remains the first donor choice for AML patients in CR1 when available. HRDs are still our next option among alternative donors. It is necessary to find strategies that have a positive impact on those outcomes that markedly affect the quality of allogeneic PBSCT and the prognosis of patients. Comparative, randomized, prospective studies with longer follow-up of haploidentical allogeneic PBSCT with other donor types are required to definitely establish its role among alternative donors.

Keywords: Acute myeloid leukemia; Bone marrow transplantation; Colombia; Donors; Hematopoietic stem cell transplantation; Myeloablative conditioning regimen; Survival.

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Conflict of interest statement

None to declare.

Figures

Figure 1
Figure 1
Comparison of overall survival of allogeneic hematopoietic stem cell transplantation, 2013 - 2019. There is no statistically significant difference between groups (P = 0.142). HRD: haploidentical related donor; MSD: HLA-matched sibling donor.
Figure 2
Figure 2
Overall and comparison of relapse-free survival in allogeneic hematopoietic stem cell transplantation, 2013 - 2019. (a) Overall of relapse-free survival. (b) Comparison of relapse-free survival. There is no statistically significant difference between groups (P = 0.188). HRD: haploidentical related donor; MSD: HLA-matched sibling donor.
Figure 3
Figure 3
Overall and comparison of non-relapse mortality after allogeneic hematopoietic stem cell transplantation, 2013 - 2019. There is no statistically significant difference between groups (P = 0.190). (a) Overall of non-relapse mortality. (b) Comparison of non-relapse mortality. HRD: haploidentical related donor; MSD: HLA-matched sibling donor.
Figure 4
Figure 4
Comparison of relapse after allogeneic hematopoietic stem cell transplantation, 2013 - 2019. There is no statistically significant difference between groups (P = 0.537). HRD: haploidentical related donor; MSD: HLA-matched sibling donor.
See this image and copyright information in PMC

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