Human leukocyte antigen-haploidentical transplantation for relapsed/refractory acute myeloid leukemia: Better leukemia-free survival with bone marrow than with peripheral blood stem cells in patients ≥55 years of age
[en] The best stem cell source for T-cell replete HLA-haploidentical transplantation with post-transplant cyclophosphamide (PTCy) remains to be determined. In this EBMT retrospective study we analyzed the impact of stem cell source on leukemia-free survival (LFS) in adult patients with primary refractory or relapsed acute myeloid leukemia (AML) given grafts from HLA-haploidentical donors with PTCy as graft-versus-host disease (GVHD) prophylaxis. A total of 668 patients (249 bone marrow (BM) and 419 peripheral blood stem cells (PBSC) recipients) met the inclusion criteria. The use of PBSC was associated with a higher incidence of grade II-IV (HR = 1.59, P = 0.029) and grade III-IV (HR = 2.08, P = 0.013) acute GVHD. There was a statistical interaction between patient age and the impact of stem cell source for LFS (P < 0.01). In multivariate Cox models, among patients <55 years, the use of PBSC versus BM resulted in comparable LFS (HR = 0.82, P = 0.2). In contrast, in patients ≥55 years of age, the use of PBSC versus BM was associated with higher non-relapse mortality (NRM) (HR = 1.7, P = 0.01), lower LFS (HR = 1.37, P = 0.026) and lower overall survival (OS) (HR = 1.33, P = 0.044). In conclusions, our data suggest that in patients ≥55 years of age with active AML at HLA-haploidentical transplantation, the use of BM instead of PBSC as stem cell source results in lower NRM and better LFS. In contrast among younger patients, the use of PBSC results in at least a comparable LFS.
Disciplines :
Hematology
Author, co-author :
BARON, Frédéric ; Université de Liège - ULiège > GIGA > GIGA I3 - Hematology ; Université de Liège - ULiège > Département des sciences cliniques ; Centre Hospitalier Universitaire de Liège - CHU > > Service d'hématologie clinique
Labopin, Myriam; EBMT Paris study office/CEREST-TC, Paris, France ; Department of Hematology, Saint Antoine Hospital, Paris, France ; INSERM UMR 938, Paris, France ; Université Pierre et Marie Curie, Paris, France
Tischer, Johanna; Klinikum Grosshadern, Med. Klinik III, Munich, Germany
Ciceri, Fabio; Ospedale San Raffaele s.r.l., Haematology and BMT, Milan, Italy
Raiola, Anna Maria; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
Blaise, Didier; Programme de Transplantation&Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
Sica, Simona; Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy ; Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
Vydra, Jan; Institute of Hematology and Blood Transfusion, Prague, Czech Republic
Fanin, Renato; Azienda Ospedaliero Universitaria di Udine, Division of Hematology, Udine, Italy
Stölzel, Friedrich; University Hospital Dresden, Medical Clinic I, TU, Dresden, Germany
Busca, Alessandro; SSCVD Trapianto di Cellule Staminali, AOU Citta della Salute e della Scienza di Torino, Torino, Italy
Diez-Martin, Jose Luis; Hospital Gregorio Marañón, Sección de Trasplante de Medula Osea, Madrid, Spain
Koc, Yener; Medicana International Hospital Istanbul, Bone Marrow Transplant Unit, Istanbul, Turkey
Nagler, Arnon ; Division of Hematology and Bone Marrow Transplantation, The Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
Mohty, Mohamad; EBMT Paris study office/CEREST-TC, Paris, France ; Department of Hematology, Saint Antoine Hospital, Paris, France ; INSERM UMR 938, Paris, France ; Université Pierre et Marie Curie, Paris, France
Human leukocyte antigen-haploidentical transplantation for relapsed/refractory acute myeloid leukemia: Better leukemia-free survival with bone marrow than with peripheral blood stem cells in patients ≥55 years of age
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