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Comparative Study
. 2024 Nov;59(11):1542-1551.
doi: 10.1038/s41409-024-02378-0. Epub 2024 Aug 15.

Comparing transplant outcomes in ALL patients after myeloablative conditioning in mismatch-related or unrelated donor settings

Salman Otoukesh  1 , Dongyun Yang  2 , Sally Mokhtari  3 , Hoda Pourhassan  1 , Vaibhav Agrawal  1 , Shukaib Arslan  1 , Idoroenyi Amanam  1 , Brian Ball  1 , Paul Koller  1 , Amandeep Salhotra  1 , Karamjeet Sandhu  1 , Ahmed Aribi  1 , Andrew Artz  1 , Ibrahim Aldoss  1 , Vinod Pullarkat  1 , Haris Ali  1 , Amanda Blackmon  1 , Pamela Becker  1 , Peter Curtin  1 , Forrest Stewart  1 , Eileen Smith  1 , Anthony Stein  1 , Guido Marcucci  1 , Stephen J Forman  1 , Ryotaro Nakamura  1 , Monzr M Al Malki  4
Affiliations
Comparative Study

Comparing transplant outcomes in ALL patients after myeloablative conditioning in mismatch-related or unrelated donor settings

Salman Otoukesh et al. Bone Marrow Transplant. 2024 Nov.

Abstract

The optimal myeloablative conditioning regimen for ALL patients undergoing hematopoietic cell transplant (HCT) with an alternative donor is unknown. We analyzed HCT outcomes ALL patients (n = 269) who underwent HCT at our center from 2010 to 2020 in complete remission (CR) after FTBI-etoposide and CNI-based GvHD prophylaxis for matched donor HCT (ETOP-package; n = 196) or FTBI-Fludarabine and post-transplant cyclophosphamide (PTCy)-based prophylaxis for HLA- mismatched (related or unrelated) donors (FLU-package; n = 64). Patients in FLU-package showed a significant delay in engraftment (p < 0.001) and lower cumulative incidence (CI) of any and extensive chronic GVHD (p = 0.009 and 0.001, respectively). At the median follow up of 4.6 years (range 1-12 years); non-relapse mortality, overall or leukemia-free survival and GVHD-free/relapse-free survival were not significantly impacted by the choice of conditioning. However, in patients at CR2 or with measurable residual disease (MRD+), there was a trend towards higher relapse after FLU-package (p = 0.08 and p = 0.07, respectively), while patients at CR1 regardless of MRD status had similar outcomes despite the package/donor type (p = 0.9 and 0.7, respectively). Our data suggests that FLU-package for alternative donors offers comparable outcomes to ETOP-package for matched donor HCT to treat ALL. Disease status and depth of remission at HCT were independent predictors for better outcomes.

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Conflict of interest statement

The authors have no competing interests.

Figures

Fig. 1
Fig. 1. Engraftment outcomes in patients with ALL receiving FTBI/FLU or FTBI/ETOP package.
a Neutrophil engraftment, b Platelet engraftment.
Fig. 2
Fig. 2. Kaplan Myer curves comparing transplant outcomes after FTBI/FLU and FTBI/ETOP packages.
a Relapse, b Non-relapse mortality, c Subgroup analysis of relapse outcomes in patients undergoing HCT with MRD+ status, and d Subgroup analysis of patients undergoing HCT at CR2+.
Fig. 3
Fig. 3. Kaplan Myer curves comparing transplant outcomes after FTBI/FLU and FTBI/ETOP packages.
a Overall survival, b Leukemia-free survival.
Fig. 4
Fig. 4. Graft-versus host disease outcomes after FTBI/FLU and FTBI/ETOP packages.
a Grade 2–4 acute GVHD at days 100 and 180 post-transplant, b grade 3–4 acute GVHD at days 100 and 180 post-transplant, c Any chronic GVHD at 12 months after transplant, and d Extensive chronic GVHD at 12 months after transplant.
See this image and copyright information in PMC

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