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.

1st State Pavlov Medical University of St Petersburg Raisa Gorbacheva Memorial Research Institute for Pediatric Oncology Hematology and Transplantation St Petersburg Russia

Anadolu Medical Center Hospital Bone Marrow Transplantation Department Kocaeli Turkey

Dél pesti Centrumkórház Országos Hematológiaiés Infektológiai Intézet Department of Haematology and Stem Cell Transplant Budapest Hungary

Department of Clinical Hematology and Cellular Therapy Saint Antoine Hospital AP HP Sorbonne University Paris France

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

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

Sorbonne Université INSERM UMR S 938 CRSA Service d'hématologie et Thérapie Cellulaire AP HP Hôpital Saint Antoine Paris France

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

University of Zagreb School of Medicine Zagreb Croatia

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