Unmanipulated haploidentical hematopoietic stem cell transplantation (HCT) with post-transplantation cyclophosphamide as graft-versus-host disease (GVHD) prophylaxis (haplo-PTCY) and unrelated double-unit umbilical cord blood transplantation (dUCBT) are feasible options for treating patients with high-risk acute myelogenous leukemia (AML). This study compared outcomes after dUCBT and haplo-HCT using peripheral blood stem cells (PBSCs) in adult patients with AML in complete remission (CR) who underwent transplantation in European Society for Blood and Marrow Transplantation (EBMT)-affiliated centers. In a population of adults with de novo AML in first or second CR, we compared outcomes after dUCBT (n = 165) and after haplo-PTCY PBSC (n = 544) performed between January 2013 and December 2018. Patients receiving in vivo antithymocyte globulin, Campath, or ex vivo T cell depletion were excluded. The median follow-up was 33 months for the haplo-PTCY arm and 52 months for the dUCBT arm. No statistically significant differences were observed between the 2 arms in the rates of grade II-IV acute graft-versus-host disease (GVHD) (hazard ratio [HR], 1.31; P = .18), grade III-IV acute GVHD (HR, 1.17; P = .56), chronic GVHD (HR, .86; P = .48), relapse (HR, 1.07; P = .77), nonrelapse mortality (NRM) (HR, .94; P = .77), leukemia-free survival (LFS) (HR, .99; P = .95), or overall survival (OS) (HR, .99; P = .97). Favorable cytogenetic risk was the sole factor predictive of lower relapse incidence (RI). Younger age at transplantation was associated with lower NRM and higher LFS and OS. Both dUCBT and haplo-PTCY with PBSCs can be considered valid approaches for adult AML patients in CR. New strategies should be investigated in both settings to define the most appropriate conditioning regimen and potentially decrease RI and NRM through better immune reconstitution and optimal supportive care.

BMT Unit Department of Hematology Institute of Hematology and Oncology Hospital Clinic Institut Josep Carreras Barcelona Spain

Bone Marrow Transplantation Department Anadolu Medical Center Hospital Turkey

CHU Bordeaux Hôpital Haut leveque Bordeaux France

Department of Haematology Hammersmith Hospital Imperial College London United Kingdom

Department of Haematology Royal Marsden Hospital London United Kingdom

Department of Hematology CHU of Liège Liège Belgium

Department of Hematology University Medical Centre Utrecht the Netherlands

Erasmus MC Cancer Institute University Medical Centre Rotterdam the Netherlands

Eurocord Hôpital Saint Louis and IUH University Paris 7 Paris France

Eurocord Hôpital Saint Louis and IUH University Paris 7 Paris France; Monacord Centre Scientifique de Monaco Monaco

Hematology and BMT Unit San Raffaele Scientific Institute Milano Italy

Hematology and BMT Unit San Raffaele Scientific Institute Milano Italy; Eurocord Hôpital Saint Louis and IUH University Paris 7 Paris France

Hematology and Cellular Therapy Service Hôpital Saint Antoine AP HP Paris France

Hematology and Cellular Therapy Service Hôpital Saint Antoine AP HP Paris France; INSERM UMR 938 Paris France

Hematology Department Hospital GU Gregorio Marañon Instituto de Investigación Sanitaria Gregorio Marañon Department of Medicine Universidad Complutense de Madrid Madrid Spain

Hematology Department University Hospital of Salamanca USAL IBSAL Salamanca Spain

Hematology Division Chaim Sheba Medical Center Tel Aviv University Ramat Gan Israel

Hematology Service Hôtel Dieu Nantes France

Hospital Universitario y Politécnico La Fe Valencia Spain and CIBERONC Madrid Spain

Humanitas Cancer Center Rozzano Italy

Institut Paoli Calmettes Marseille France

Institute of Hematology and Blood Transfusion Prague Czech Republic

Medicana International Istanbul Turkey

University Hospital of Patras Patras Greece

Vanderbilt University Medical Center Nashville Tennessee

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