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Comparative Study
. 2024 Dec;205(6):2376-2386.
doi: 10.1111/bjh.19825. Epub 2024 Oct 22.

Comparison of HLA-haploidentical donors with post-transplant cyclophosphamide versus HLA-matched unrelated donors in peripheral blood stem cell transplantation for acute myeloid leukaemia

Makoto Moriguchi  1 , Hirohisa Nakamae  1 , Mitsutaka Nishimoto  1 , Junichi Sugita  2 , Masamitsu Yanada  3 , Tomomi Toubai  4 , Yuta Hasegawa  5 , Masayuki Hino  1 , Tetsuya Nishida  6 , Naoki Kurita  7 , Masashi Sawa  8 , Takahiro Fukuda  9 , Atsushi Jinguji  10 , Shuichi Ota  2 , Ken-Ichi Matsuoka  11 , Tetsuya Eto  12 , Nobuhiro Hiramoto  13 , Toshihiko Ando  14 , Koji Kawamura  15 , Yoshinobu Kanda  16 , Yoshiko Atsuta  17   18 , Marie Ohbiki  17   18   19 , Hideki Nakasone  20   21 , Takaaki Konuma  22
Affiliations
Comparative Study

Comparison of HLA-haploidentical donors with post-transplant cyclophosphamide versus HLA-matched unrelated donors in peripheral blood stem cell transplantation for acute myeloid leukaemia

Makoto Moriguchi et al. Br J Haematol. 2024 Dec.

Abstract

HLA-haploidentical haematopoietic cell transplantation with post-transplant cyclophosphamide (PTCy-haplo) is emerging as an effective alternative due to donor availability and safety. We conducted a nationwide retrospective study comparing the outcomes of PTCy-haplo with both anti-thymocyte globulin (ATG)-free and ATG-administered matched unrelated donors (MUD) transplantation, using peripheral blood stem cells as the first transplantation for acute myeloid leukaemia (AML). Our study showed a lower and slower haematopoietic recovery and a higher incidence of infection-related deaths after PTCy-haplo than after MUD transplantation. In addition, we revealed an increased risk of acute and chronic graft-versus-host disease (GVHD) in ATG-free MUD transplantation in comparison to PTCy-haplo. For grades III-IV acute GVHD, the hazard ratio (HR) was 2.71 (95% CI, 1.46-5.01), and for extensive chronic GVHD, the HR was 3.11 (95% CI, 2.07-4.68). There was no significant difference regarding overall survival amongst the groups. In addition, GVHD-free relapse-free survival (GRFS) was lower in ATG-free MUD transplantation than in PTCy-haplo (HR, 1.46; 95% CI, 1.17-1.82). Notably, ATG-administered MUD transplantation showed no significant difference in GRFS from PTCy-haplo, negating the advantage of PTCy. Our results suggest that PTCy-haplo could be viable for AML patients without an HLA-matched related donor.

Keywords: acute myeloid leukaemia; haploidentical donor; matched unrelated donor; peripheral blood stem cell transplantation; post‐transplant cyclophosphamide.

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References

REFERENCES

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