Availability of haploidentical donors has broadened utilization of allogeneic hematopoietic cell transplantation (allo-HCT). Peripheral blood stem cells (PBSC) are being used with increased frequency in haploidentical allo-HCT. We evaluated extent of HLA disparity (2-3/8 versus 4/8 HLA antigen mismatches) on post-allograft outcomes when using T-cell replete PBSC from haploidentical donors for acute myeloid leukemia in first complete remission. Primary objectives entailed assessing cumulative incidence of grade 2-4 acute graft-versus-host disease (GVHD) and chronic GVHD (any grade). A total of 645 patients received a haploidentical allo-HCT from a donor with either 2-3 of 8 HLA antigen mismatches (n = 180) or with 4 of 8 HLA antigen mismatches (n = 465). Presence of 2-3 of 8 versus 4 of 8 HLA mismatches did not affect the incidence of acute GVHD (grade 2-4) and chronic GVHD (any grade). Overall survival (OS), leukemia-free survival (LFS) relapse incidence (RI), nonrelapse mortality and the composite endpoint of GVHD-free relapse-free survival were also similar among the groups. Pertaining to HLA-B leader matching effect, our analysis did not discern any difference in aforementioned post-allograft outcomes for this variable. However, in univariate analysis, absence of an antigen mismatch in HLA-DPB1 showed a trend for better OS. Notwithstanding inherent limitations associated with registry data, our results did not show an advantage of selecting a haploidentical donor with 2-3 of 8 HLA antigen mismatches over one with 4 of 8 HLA antigen mismatches when using PBSC as the cell source. Adverse cytogenetics remains a major adverse determinant of inferior OS and LFS and a higher RI. Using reduced-intensity conditioning yielded worse OS and LFS.

Acute Leukemia Working Party of EBMT Paris France

Alberts Cellular Therapy Netcare Pretoria East Hospital Pretoria South Africa

ASST Grande Ospedale Metropolitano Niguarda Hematology Department Milano Italy

Augsburg University Hospital and Medical Faculty Augsburg Germany

Azienda Ospedaliero Universitaria di Udine Division of Hematology Italy

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

CHU Grenoble Alpes Université Grenoble Alpes Service d`Hématologie France

Department of Hematology Hôpital Saint Antoine Sorbonne University and INSERM UMRs 938 Paris France

Department of Oncology and Hematology University of Milan and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII Bergamo Italy

Division of Hematology and Bone Marrow Transplantation The Chaim Sheba Medical Center Tel Hashomer Ramat Gan Israel

Division of Hematology Oncology and Blood and Marrow Transplantation and Cellular Therapy Program Mayo Clinic Jacksonville FL USA

H SS Antonio e Biagio Haematology Department Alessandria Italy

Hematology Department Hospital Universitari i Politècnic La Fe Avinguda Fernando Abril Martorell Valencia Spain

Hospital Sirio Libanes Hematology Bone Marrow Transplant Unit Sao_Paulo Brazil

Institute of Hematology and Blood Transfusion Prague Czech Republic

IRCCS Istituto Clinico Humanitas Rozzano Milano Italy

Medicana International Hospital Istanbul Bone Marrow Transplant Unit Istanbul Turkey

Medizinische Universitaet Wien Klinik fuer Innere Medizin 1 Knochenmarktransplantation Vienna Austria

Ospedale San Raffaele s r l Haematology and BMT Milano Italy

Paediatric Haematology Oncology Fondazione IRCCS Policlinico San Matteo Pavia Italy

Programme de Transplantation and Therapie Cellulaire Department of Hematology Management Sport Cancer Lab Aix Marseille University Institut Paoli Calmettes Marseille France

Reina Sofia University Hospital IMIBIC University of Cordoba Spain

S S C 5 D Trapianto di Cellule Staminali A O U Citta della Salute e della Scienza di Torino Italy

Service d'Hématologie Clinique et Thérapie Cellulaire CHU Bordeaux France

Turku University Hospital TD7 Turku Finland

Unita Operativa di Ematologia e Trapianto di cellule staminali Lecce Italy

University Hospital Eppendorf Bone Marrow Transplantation Centre Hamburg Germany

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