Whether to choose Haploidentical (Haplo) or one-antigen mismatched unrelated donor (1Ag-MMUD) hematopoietic cell transplantation (HCT) with post-transplant cyclophosphamide (PTCy) remains an unanswered question. We compared PTCy- Haplo-HCT to PTCy-1Ag-MMUD-HCT for acute myeloid leukemia (AML) in complete remission (three groups: 1Ag-MMUD using peripheral blood (1Ag-MMUD-PB; n = 155); Haplo using bone marrow (Haplo-BM; n = 647) or peripheral blood (Haplo-PB; n = 949)). Haplo-BM and Haplo-PB had a higher non-relapse mortality (NRM) compared to 1Ag-MMUD-PB (HR 2.28, 95% CI 1.23-4.24, p < 0.01; HR 2.65, 95% CI 1.46-4.81, p < 0.01, respectively). Haplo groups experienced a lower leukemia-free survival (LFS) compared to 1Ag-MMUD-PB (Haplo-BM: HR 1.51, 95% CI 1.06-2.14, p = 0.02; Haplo-PB: 1.47, 95% CI 1.05-2.05, p = 0.02); overall survival (OS) was also lower in Haplo-HCT (Haplo-BM: HR 1.50, 95% CI 1.02-2.21, p = 0.04; Haplo-PB: HR 1.51, 95% CI 1.05-2.19, p = 0.03). No differences were observed for graft-versus-host/relapse-free survival (GRFS) and relapse incidence (RI). Haplo-BM was associated with a lower risk of grade III-IV acute graft-versus-host disease (GVHD) (HR 0.44, 95% CI 0.24-0.81; p < 0.01), while no statistical differences were observed between groups for grade II-IV aGVHD and for cGVHD. Use of PTCy in 1Ag-MMUD-HCT is a valid alternative to consider when using alternative donors. Larger analysis of 1Ag-MMUD versus Haplo-HCT are warranted.

Alberts Cellular Therapy Netcare Pretoria East Hospital Pretoria South Africa

Anadolu Medical Center Hospital Bone Marrow Transplantation Department Kocaeli Turkey

ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA Hematology Department Milano Italy

Bone Marrow Transplantation Program Department of Internal Medicine American University of Beirut Medical Center Beirut Lebanon

Chaim Sheba Medical Center Tel Hashomer Israel

CHU Bordeaux Hôpital Haut leveque Pessac France

CHU Grenoble Alpes Université Grenoble Alpes Service d'Hématologie Grenoble France

Department of Clinical Medicine and Surgery Federico 2 University of Naples Naples Italy

Division of Stem Cell Transplantation and Cellular Therapies Grande Ospedale Metropolitano Bianchi Melacrino Morelli Reggio Calabria Italy

EBMT Statistical Unit Paris France

Federico 2 University of Naples Hematology Department Naples Italy

Florence Nightingale Sisli Hospital Hematopoietic SCT Unit Istanbul Turkey

Fondazione Policlinico A Gemelli IRCCS Roma Italy; Istituto di Ematologia Università Cattolica del Sacro Cuore Roma Italy

Goethe Universitaet Medizinische Klinik 2 Hämatologie Medizinische Onkologie Frankfurt Main Germany

Hematology Department Complejo Asistencial Universitario de Salamanca IBSAL; Centro de Investigación del Cáncer IBMCC Salamanca Spain

Hematology Department Hôpital Saint Antoine Service d'Hématologie Thérapie Cellulaire Paris France

Hematology department Hospital General Universitario Gregorio Marañon Instituto de Investigación Sanitaria Gregorio Marañon Universidad Complutense Medicina Madrid Spain

Hematology Service Institute of Hematology and Blood Transfusion Prague Czech Republic

Hopital St Louis Dept of Hematology BMT Paris France

Hospital Clinic BMT Unit Dept of Hematology IDIBAPS Institut Josep Carreras Barcelona Spain

Hospital U Marqués de Valdecilla Servicio de Hematología Hemoterapia Santander Spain

Imperial College Department of Haematology Hammersmith Hospital London United Kingdom

IRCCS Humanitas Research Hospital Rozzano Milan Italy

Klinikum Grosshadern Med Klinik 3 Munich GermanyKlinikum Grosshadern Med Klinik 3 Munich Germany

Medicana International Istanbul Turkey

Ospedale San Raffaele s r l Haematology and BMT Milano Italy

Programme de Transplantation and Therapie Cellulaire Institut Paoli Calmettes Aix Marseille Univ CNRS INSERM CRCM Marseille France

R M Gorbacheva Research Institute Pavlov University Saint Petersburg Russian Federation

Sorbonne Universités UPMC Univ Paris 06 INSERM Centre de Recherche Saint Antoine Paris France

SSCVD Trapianto di Cellule Staminali AOU Città della Salute e della Scienza di Torino Turin Italy

Universite Paris 4 Hopital la Pitié Salpêtrière Hematologie Clinique Paris France

University Medical Center Groningen University of Groningen Groningen The Netherlands

UOC Ematologia e Trapianto di Midollo Osseo IRCCS Ospedale Policlinico San Martino Genova Genova Italy

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