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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.
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Comparable outcomes of haploidentical, 10/10 and 9/10 unrelated donor transplantation in adverse karyotype AML in first complete remission
Lorentino, F., Labopin, M., Bernardi, M., Ciceri, F., Socie, G., Cornelissen, J. J., Esteve, J., Ruggeri, A., Volin, L., Yacoub-Agha, I., et al
American journal of hematology. 2018
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Abstract
Allogeneic hematopoietic stem cell transplantation (HSCT) is the most powerful therapy preventing relapse in patients with adverse cytogenetics acute myeloid leukemia (AML) in first complete remission (CR1). In the absence of a matched related donor, potential alternatives include 10/10, 9/10 HLA-matched unrelated (UD) or haploidentical (Haplo) donors. We analyzed clinical outcomes of patients undergoing T-cell repleted Haplo (n=74), 10/10 UD (n=433) and 9/10 UD HSCT (n=123) from 2007 to 2015, reported to the EBMT Registry. Adverse risk AML was defined according to the 2017 ELN cytogenetic risk classification. The 2-year non-relapse mortality was 19% for Haplo, 18% for 10/10 UD and 18% for 9/10 UD (p=0.9). The relapse incidence was not significantly affected by donor source, with a 2-year incidence of 27% for Haplo HSCT, 39% for 10/10 UD and 37% for 9/10 UD SCT (p=0.3). We show comparable probabilities of leukemia-free survival (LFS) and overall survival (OS) at 2 years among Haplo HSCT, 10/10 UD SCT and 9/10 UD SCT (53% and 59%, 43% and 50%, 44% and 50%, respectively, p=0.5 for both parameters). The type of donor was not significantly associated with either acute or chronic graft-versus-host disease incidence. Using multivariable Cox model, Haplo HSCT recipients experienced comparable OS and LFS to 10/10 and 9/10 UD. In the present series of adverse cytogenetics AML patients in CR1, Haplo HSCT recipients had comparable outcomes to those of 10/10 and 9/10 UDs, suggesting that all these types of HSCT may be considered a valid option in this high risk population. This article is protected by copyright. All rights reserved.