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. 2024 Jan 1;16(1):e2024002.
doi: 10.4084/MJHID.2024.002. eCollection 2024.

Haploidentical Transplant with Post-Transplant Cyclophosphamide for Acute Myeloid Leukaemia and Myelodysplastic Syndromes Patients: The Role of Previous Lines of Therapy

Daniele Avenoso  1 , Fabio Serpenti  1 , Liron Barnea Slonim  2 , Styliani Bouziana  1 , Francesco Dazzi  1 , Guy Hannah  1 , Michelle Kenyon  1 , Varun Mehra  1 , Austin Kulasekararaj  1 , Pramila Krishamurthy  1 , Mili Naresh Shah  1 , Sharon Lionel  1 , Antonio Pagliuca  1 , Victoria Potter  1
Affiliations

Haploidentical Transplant with Post-Transplant Cyclophosphamide for Acute Myeloid Leukaemia and Myelodysplastic Syndromes Patients: The Role of Previous Lines of Therapy

Daniele Avenoso et al. Mediterr J Hematol Infect Dis. .

Abstract

Background: Allogeneic haematopoietic stem-cell transplant is an option, potentially curative, for high-risk acute myeloid leukaemia (AML) and myelodysplastic syndrome (MDS) patients. Post-transplant cyclophosphamide administration allows for the selection of haploidentical donors in patients who are eligible for the procedure but do not have a fully matched donor since it can overcome the HLA barrier. There is still an active debate on whether intensifying the conditioning regimen is necessary with haploidentical donors when peripheral blood stem cells are used as the graft source. Herein, we report our decennial experience of haploidentical stem-cell transplant using peripheral blood stem cells (haplo-PBSC) at King's College Hospital.

Objectives: The primary objective was to evaluate overall survival (OS) following haplo-PBSC. Secondary objectives were total OS for patients with less than two previous lines of therapy, OS according to cytomegalovirus (CMV) reactivation, incidence of transplant-related mortality (TRM), graft-versus-host disease (GVHD) and GVHD-relapse-free survival (GRFS).

Results: One-year and three-year total OS were 62% and 43%, respectively, with a median OS of 22 months. One-year and three-year OS for patients with ≤2 and those with >2 previous lines of therapy were 72% and 55%, and 60% and 22%, respectively (p-value=0.04). The median OS in patients with >2 previous and ≤2 lines of therapy was 16 and 49 months, respectively. Cumulative incidence (CI) of relapse was 25% with a median time to relapse of 5 months (range 1 - 38 months).

Conclusions: Haploidentical haematopoietic stem-cell transplant is potentially curative in chemosensitive AML and MDS and offers a high rate of prolonged remission. Our cohort further confirms the role of consolidative haploidentical transplant in patients in complete remission and highlights that patients with heavily pre-treated disease may not benefit from this strategy.

Keywords: AML; Haplo-identical stem cell transplantation; MDS.

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Conflict of interest statement

Competing interests: The authors declare no conflict of Interest.

Figures

Figure 1
Figure 1
Haplo-HSCT population at King’s College Hospital in 10 years. *Two cases of primary induction failure achieved first complete remission (CR1) after two lines of therapies; one patient achieved CR1 after three lines of therapy. +Two cases needed three lines of therapy to achieve second complete remission (CR2).
Figure 2
Figure 2
Overall survival for AML and MDS at haplo-HSCT at King’s College Hospital between August 2010 and August 2021.
Figure 3
Figure 3
OS for patients with ≤2 previous line of therapy (red line) versus OS for patients with >2 previous line of therapy (blue line).
Figure 4
Figure 4
Cumulative incidence of chronic GVHD.
See this image and copyright information in PMC

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