HLA-matching largely contributes to unrelated donor hematopoietic cell transplantation (UD-HCT) success but, due to the selective deletion of alloreactive T-cells, post-transplantation cyclophosphamide (PTCy) could modulate its negative impact on outcomes. We retrospectively compared acute leukemia patients receiving 10/10 or 9/10 HLA allele-matched UD-HCT with PTCy-GvHD prophylaxis between 2010 and 2017, reported to EBMT registry. The 100-day incidence of grade ≥2 and grade ≥3 aGvHD were comparable for 10/10 and 9/10 UD (28% versus 28%, p = 0.8 and 10% versus 8%, p = 0.5, respectively). The 2-year cGvHD and extensive cGvHD were similar between 10/10 and 9/10 UD (35% versus 44%, p = 0.2 and 21% versus 20%, p = 0.6, respectively). The 2-year nonrelapse mortality was 20% after 10/10 and 16% after 9/10 UD-HCT (p = 0.1). Relapse incidence at 2-year was 24% for 10/10 and 28% for 9/10 UD-HCT (p = 0.4). Leukemia-free survival at 2-year was the same for 10/10 and 9/10 UD (56 and 56%, p = 0.6, respectively), with comparable overall survival (62 and 59%, p = 0.9, respectively). Multivariate analysis showed no effect of HLA-matching on outcomes. An advanced disease status and patient disability remained the most important factors portending a worse survival. PTCy could alleviate the detrimental effect of HLA-allele mismatching in UD-HCT, potentially expanding the donor pool for acute leukemia patients.

Acute Leukemia Working Party of EBMT Paris France

Asklepios Klinik St George Lohmühlenstrasse Hamburg Germany

Cellular Therapy and Immunobiology Working Party Marseille France

Centre d'Investigations Cliniques en Biothérapies Institut Paoli Calmette Marseille Marseille France

Department of Hematology University Medical Center Amsterdam Netherlands

Department of Pediatric Hematology and Oncology IRCCS Bambino Gesù Children's Hospital Rome Italy

Department of Stem cell Transplantation University Hospital Eppendorf Hamburg Germany

Erasmus MC Daniel den Hoed Cancer Centre Rotterdam Netherlands

German Cancer Consortium Heidelberg Germany

Hematology and Bone Marrow Transplantation Unit IRCCS San Raffaele Scientific Institute Milano Italy

Hôpital Saint Antoine Paris University UPMC INSERM U938 Paris France

Hospital Clinic Institute of Hematology and Oncology Barcelona Spain

Institute for Experimental Cellular Therapy Essen University Hospital Essen Germany

Institute of Hematology and Blood Transfusion Prague Czech Republic

Programme de Transplantation and Thérapie Cellulaire Centre de Recherche en Cancérologie de Marseille Institut Paoli Calmettes Marseille France

Raisa Gorbacheva Memorial Research Institute for Pediatric Oncology Hematology and Transplantation St Petersburg Russia

Service d'Hématologie Clinique et Thérapie Cellulaire Hôpital Saint Antoine AP HP Paris France

Unit of Immunogenetics Leukemia Genomics and Immunobiology IRCCS San Raffaele Scientific Institute Milano Italy

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Young (<35 years) haploidentical versus old (≥35 years) mismatched unrelated donors and vice versa for allogeneic stem cell transplantation with post-transplant cyclophosphamide in patients with acute myeloid leukemia in first remission: a study on behalf of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation

Tacrolimus versus cyclosporine a combined with post-transplantation cyclophosphamide for AML In first complete remission: a study from the acute leukemia working party (EBMT)

Allogeneic stem cell transplantation for patients with acute myeloid leukemia (AML) in second complete remission (CR2) transplanted from unrelated donors with post-transplant cyclophosphamide (PTCy). A study on behalf of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation