1.
Donor selection for a second allogeneic stem cell transplantation in AML patients relapsing after a first transplant: a study of the Acute Leukemia Working Party of EBMT
Shimoni, A., Labopin, M., Finke, J., Ciceri, F., Deconinck, E., Kroger, N., Gramatzki, M., Stelljes, M., Blaise, D., Stoelzel, F., et al
Blood cancer journal. 2019;9(12):88
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Abstract
Second allogeneic stem-cell transplantation (SCT2) is a therapeutic option for patients with AML relapsing after a first transplant. Prior studies have shown similar results after SCT2 from the same or different donor; however, there are limited data on second non-T-depleted haplo-identical transplant in this setting. We retrospectively analyzed SCT2 outcomes in 556 patients, median age 46 years, relapsing after first transplant given in CR1. Patients were divided into three groups based on SCT2 donor (donor2): same donor (n = 163, sib/sib-112, UD/UD-51), different matched donor (n = 305, sib/different sib-44, sib/UD-93, UD/different UD-168), or haplo-donor (n = 88, sib/haplo-45, UD/haplo-43). Two-year leukemia-free survival (LFS) rate after SCT2 was 23.5%, 23.7%, and 21.8%, respectively (P = 0.30). Multivariate analysis showed no effect of donor2 type on relapse: hazard ratio (HR) 0.89 (P = 0.57) and 1.11 (P = 0.68) for different donor and haplo-donor compared to same donor, respectively. However, donor2 did predict for non-relapse mortality (NRM) after SCT2: HR 1.21 (P = 0.50) and 2.08 (P = 0.03), respectively, and for LFS: HR 1.00 (P = 0.97) and 1.43 (P = 0.07), respectively. In conclusion, SCT2 with the same or different matched donor is associated with similar outcomes in patients with relapsed AML. Non-T-depleted haplo-identical transplant may be associated with higher NRM, similar relapse rate and with no better results in this setting.
PICO Summary
Population
Patients with relapsed AML undergoing a second allogeneic stem cell transplant (SCT2, n=556)
Intervention
Same donor (n = 163)
Comparison
Different matched donor (n =305), or haplo-donor (n = 88).
Outcome
Two-year leukemia-free survival (LFS) rate after SCT2 was 23.5%, 23.7%, and 21.8%, respectively. Multivariate analysis showed no effect of donor2 type on relapse for different donor and haplo-donor compared to same donor, respectively. However, donor2 did predict for non-relapse mortality (NRM) after SCT2: HR 1.21 and 2.08 respectively, and for LFS: HR 1.00 and 1.43, respectively.
2.
Influence of alternative donor type on early survival after hematopoietic stem cell transplantation for acute myeloid leukemia lacking a sibling donor
Deteix, C., Mesnil, F., Furst, S., Milpied, N., Yakoub-Agha, I., Fegueux, N., Latour, R. P., Mohty, M., Chevallier, P., Labussiere Wallet, H., et al
Bone marrow transplantation. 2019
Abstract
Allogeneic hematopoietic stem cell transplantation is the only potentially curative therapy for acute myeloid leukemia. In the absence of an HLA-matched related or unrelated donor (MRD or MUD), the best alternative donor source remains controversial. Umbilical cord blood and haploidentical donors offer a shorter delay from indication to transplantation. This retrospective multicentre study of a French registry compares overall survival in the 18 months following registration in the absence of a MRD between four types of donors. Between 2012 and 2016, 1302 patients were transplanted using MUD (control, n = 803), mismatched MUD (n = 219), umbilical cord blood (n = 153) and haploidentical (n = 127) donors. Multivariate analyses were conducted for overall survival after registration, after transplant, and transplant-related mortality. After adjustment for variables, the type of donor did not influence any of the three end points. Our results confirmed the significant negative impact of longer time between registration and transplant: HR = 1.04 [1.02-1.06] (p < 0.0001). This indicates a positive correlation between better survival and shorter registration-to-transplantation wait time. In the absence of a sibling donor, the alternative stem cell source does not impact early survival in acute myeloid leukemia patients. The minimization of registration-to-transplantation time should be considered when weighing the alternative donor options.
3.
HLA mismatched donors in patients with myelodysplastic syndrome: an EBMT registry analysis
Robin, M., Porcher, R., Ruggeri, A., Blaise, D., Wolschke, C., Koster, L., Angelucci, E., Stolzel, F., Potter, V., Yakoub-Agha, I., et al
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 2018
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Abstract
Recently, haplo-identical transplantation (haplo) using post-transplant cyclophosphamide (PTCy) has been reported to give very encouraging results in patients with hematological malignancies. Patients who have no HLA-matched donor currently have the choice between a mismatched unrelated donor, an unrelated cord blood donor and a haplo-identical related donor. The aim of our study is to compare the outcome of patients with myelodysplastic syndrome (MDS) who have been transplanted from a haplo-identical donor using PTCy, a HLA mismatched unrelated donor (marrow or peripheral blood stem cells) or an unrelated mismatched cord blood donor (CB). 833 MDS patients from the EBMT registry, transplanted between 2011 and 2016, were identified. The potential benefit of haplo was compared to mismatched unrelated and CB in an adjusted and weighted model taking into account potential confounders and other prognostic variables. Haplo was at lower risk of acute GVHD than mismatched unrelated donor (p=0.010) but at similar risk than CB. Progression-free survival was better after haplo (vs. mismatched unrelated, p=0.056, vs. CB, p=0.003) and overall survival tended to be superior after haplo (vs. mismatched unrelated, p=0.082, vs. CB, p=0.002). Non-relapse mortality was not significantly different between haplo and mismatched unrelated donor. Relapse risk was not influenced by the type of donor. In conclusion, patients with MDS from the EBMT registry receiving HSCT from a haplo donor have significant better outcome than CB and at least similar or better outcome than mismatched unrelated donor. Prospective studies comparing the type of donors will be needed to confirm this assumption.