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Posttransplant cyclophosphamide-based anti-graft-vs-host disease prophylaxis in patients with acute lymphoblastic leukemia treated in complete remission with allogeneic hematopoietic cell transplantation from human leukocyte antigen-mismatched unrelated donors versus haploidentical donors: A study on behalf of the ALWP of the EBMT
A. Nagler, M. Labopin, M. Arat, P. Reményi, Y. Koc, D. Blaise, E. Angelucci, J. Vydra, A. Kulagin, G. Socié, M. Rovira, S. Sica, M. Aljurf, Z. Gülbas, N. Kröger, E. Brissot, Z. Peric, S. Giebel, F. Ciceri, M. Mohty
Language English Country United States
Document type Journal Article
PubMed
36110063
DOI
10.1002/cncr.34452
Knihovny.cz E-resources
- MeSH
- Precursor Cell Lymphoblastic Leukemia-Lymphoma * drug therapy MeSH
- Acute Disease MeSH
- Cyclophosphamide therapeutic use MeSH
- Adult MeSH
- HLA Antigens MeSH
- Mycophenolic Acid therapeutic use MeSH
- Humans MeSH
- Graft vs Host Disease * prevention & control MeSH
- Unrelated Donors MeSH
- Transplantation Conditioning adverse effects MeSH
- Retrospective Studies MeSH
- Hematopoietic Stem Cell Transplantation * adverse effects MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Publication type
- Journal Article MeSH
BACKGROUND: Both mismatched unrelated donor (MMUD) and haploidentical (haplo) transplantation are valid options in patients with high-risk acute lymphoblastic leukemia (ALL) lacking a matched donor. METHODS: The study compared the outcomes of adult patients with ALL in complete remission (CR) who underwent 9/10 MMUD versus haplo transplantation with posttransplant cyclophosphamide (PTCy) as graft-vs-host disease (GVHD) prophylaxis in 2010-2020. RESULTS: The study included 781 patients (MMUD, 103; haplo, 678). The median age was 40 (19-73) and 38 (18-75) years, respectively (p = .51). The most frequent immunosuppression agents added to PTCy were mycophenolate mofetil (MMF)/cyclosporine A and MMF/tacrolimus. In vivo T-cell depletion (anti-thymocyte globulin) was administered to 21% and 8% of the transplants, respectively (p < .0001). Neutrophil (absolute neutrophil count >0.5 × 109 /L) recovery was achieved in 97.1% versus 96.7% versus (p = 1) in MMUD and haplo, respectively. Nonrelapse mortality and relapse incidence were not significantly different between MMUD and haplo, hazard ratio (HR) = 1.45 (95% confidence interval [CI], 0.81-2.62; p = .21) and HR = 0.81 (95% CI, 0.52-1.28, p = .38), respectively. HRs for leukemia-free survival, overall survival, and GVHD-free, relapse-free survival were respectively, HR = 1.05 (95% CI, 0.73-1.50, p = .8), HR = 1.17 (95% CI, 0.77-1.76, p = .46), and HR = 1.07 (95% CI, 0.78-1.46, p = .7) for haplo compared to MMUD. Acute (a)GVHD grade 2-4 was significantly higher with haplo, HR = 1.73 (95% CI, 1.08-2.76, p = .023), whereas aGVHD grade 3-4 and chronic GVHD did not differ significantly between the two transplant groups. CONCLUSION: Outcomes of MMUD and haplo transplants with PTCy-based GVHD prophylaxis for ALL patients in CR are similar, apart from a higher incidence of aGVHD with haplo transplants.
Anadolu Medical Center Hospital Bone Marrow Transplantation Department Kocaeli Turkey
European Society for Blood and Marrow Transplantation Paris Study Office CEREST TC Paris France
Hematology and Bone Marrow Transplant IRCCS San Raffaele Scientific Institute Milan Italy
Hematology Division Chaim Sheba Medical Center Tel Hashomer Israel
Hopital St Louis Department of Hematology BMT Paris France
Hospital Clinic Department of Hematology Institute of Hematology and Oncology Barcelona Spain
Institute of Hematology and Blood Transfusion Servicio de Hematología Prague Czech Republic
Istanbul Florence Nightingale Hospital HSCT Unit Istanbul Turkey
King Faisal Specialist Hospital and Research Centre Oncology Riyadh Saudi Arabia
Maria Sklodowska Curie National Research Institute of Oncology Gliwice Poland
Medicana International Hospital Istanbul Bone MarrowTransplant Unit Istanbul Turkey
Ospedale San Martino Department of Haematology 2 Genoa Italy
Sorbonne University INSERM Saint Antoine Research Centre Paris France
Universita Cattolica S Cuore Istituto di Ematologia Ematologia Rome Italy
University Hospital Eppendorf Bone Marrow Transplantation Centre Hamburg Germany
References provided by Crossref.org
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