Optimal conditioning for adults with acute lymphoblastic leukemia (ALL) treated with haploidentical hematopoietic cell transplantation (haplo-HCT) and post-transplant cyclophosphamide has not been established so far. We retrospectively compared outcomes for two myeloablative regimens: fludarabine + total body irradiation (Flu-TBI, n = 117) and thiotepa + iv. busulfan + fludarabine (TBF, n = 119). Patients transplanted either in complete remission (CR) or with active disease were included in the analysis. The characteristics of both groups were comparable except for patients treated with TBF were older. In univariate analysis the incidence of non-relapse mortality (NRM) at 2 years was increased for TBF compared to Flu-TBI (31% vs. 19.5%, p = 0.03). There was a tendency towards reduced incidence of relapse after TBF (p = 0.11). Results of multivariate analysis confirmed a reduced risk of NRM using Flu-TBI (HR = 0.49, p = 0.03). In the analysis restricted to patients treated in CR1 or CR2, the use of Flu-TBI was associated with a decreased risk of NRM (HR = 0.34, p = 0.009) but an increased risk of relapse (HR = 2.59, p = 0.01) without significant effect on survival and graft-versus-host disease. We conclude that for haplo-HCT recipients with ALL, Flu-TBI may be preferable for individuals at high risk of NRM while TBF should be considered in cases at high risk of relapse.

Azienda Ospedaliera Universitaria Careggi Cell Therapy and Transfusion Medicine Unit Firenze Italy

BMT unit Clinica Ematologica Fondazione IRCCS Policlinico San Matteo Pavia Italy

BMT Unit University Hospital of Patras Patras Greece

Centre for Haematology Imperial College London Hammersmith Hospital London United Kingdom

Department of Bone Marrow Transplantation and Onco Hematology Maria Sklodowska Curie National Research Institute of Oncology Gliwice Branch Gliwice Poland

Department of Hematology Oncology Vanderbilt University Medical Center Nashville USA

Department of Internal Medicine University of Zagreb School of Medicine Zagreb Croatia

Division of Hematology and Bone Marrow Transplantation Chaim Sheba Medical Center Tel Aviv University Ramat Gan Israel

EBMT Paris study office; Department of Haematology Saint Antoine Hospital; INSERM UMR 938 Sorbonne University Paris France

Hematology and Transplant Center IRCCS Ospedale Policlinico San Martino Genova Italy

Hôpital Saint Antoine Paris France

Hopital St Louis Dept of Hematology BMT Paris France

Hospital Clinic Institute of Hematology and Oncology Dept of Hematology Barcelona Spain

Institute of Hematology and Blood Transfusion Servicio de Hematología Prague Czech Republic

King Faisal Specialist Hospital and Research Centre Oncology Riyadh Saudi Arabia

Klinikum Grosshadern Med Klinik 3 Munich Germany

Nightingale Sisli Hospital Hematopoietic SCT Unit Istanbul Turkey

Ospedale S Camillo Forlanini Dept of Hematology and BMT Rome Italy

Ospedale San Gerardo Clinica Ematologica dell'Universita Milano Biocca Monza Italy

Universita Cattolica S Cuore Istituto di Ematologia Ematologia Rome Italy

University Hospital Maastricht Dept Internal Med Hematology Oncology Maastricht The Netherlands

University of Napoli 'Federico II' Medical School Division of Hematology Napoli Italy

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