1.
Are syngeneic donors a viable donor option in allogeneic haematopoietic cell transplantation for MDS? A brief report on behalf of the Chronic Malignancies Working Party of the EBMT and review of current literature
Robin, M., Gras, L., Koster, L., Saccardi, R., Finke, J., Forcade, E., Rovira, M., Kobbe, G., Reményi, P., Apperley, J., et al
Bone marrow transplantation. 2023
2.
Post-transplant cyclophosphamide in one-antigen mismatched unrelated donor transplantation versus haploidentical transplantation in acute myeloid leukemia: a study from the Acute Leukemia Working Party of the EBMT
Battipaglia, G., Galimard, J. E., Labopin, M., Raiola, A. M., Blaise, D., Ruggeri, A., Koc, Y., Gülbas, Z., Vitek, A., Sica, S., et al
Bone marrow transplantation. 2022
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Editor's Choice
Abstract
Whether to choose Haploidentical (Haplo) or one-antigen mismatched unrelated donor (1Ag-MMUD) hematopoietic cell transplantation (HCT) with post-transplant cyclophosphamide (PTCy) remains an unanswered question. We compared PTCy- Haplo-HCT to PTCy-1Ag-MMUD-HCT for acute myeloid leukemia (AML) in complete remission (three groups: 1Ag-MMUD using peripheral blood (1Ag-MMUD-PB; n = 155); Haplo using bone marrow (Haplo-BM; n = 647) or peripheral blood (Haplo-PB; n = 949)). Haplo-BM and Haplo-PB had a higher non-relapse mortality (NRM) compared to 1Ag-MMUD-PB (HR 2.28, 95% CI 1.23-4.24, p < 0.01; HR 2.65, 95% CI 1.46-4.81, p < 0.01, respectively). Haplo groups experienced a lower leukemia-free survival (LFS) compared to 1Ag-MMUD-PB (Haplo-BM: HR 1.51, 95% CI 1.06-2.14, p = 0.02; Haplo-PB: 1.47, 95% CI 1.05-2.05, p = 0.02); overall survival (OS) was also lower in Haplo-HCT (Haplo-BM: HR 1.50, 95% CI 1.02-2.21, p = 0.04; Haplo-PB: HR 1.51, 95% CI 1.05-2.19, p = 0.03). No differences were observed for graft-versus-host/relapse-free survival (GRFS) and relapse incidence (RI). Haplo-BM was associated with a lower risk of grade III-IV acute graft-versus-host disease (GVHD) (HR 0.44, 95% CI 0.24-0.81; p < 0.01), while no statistical differences were observed between groups for grade II-IV aGVHD and for cGVHD. Use of PTCy in 1Ag-MMUD-HCT is a valid alternative to consider when using alternative donors. Larger analysis of 1Ag-MMUD versus Haplo-HCT are warranted.
PICO Summary
Population
Adults with acute myeloid leukaemia, undergoing allo-HCT with post-transplant cyclophosphamide in first or second complete remission, identified from the EBMT database (n=1751)
Intervention
Haploidentical transplantation: Haplo using bone marrow (Haplo-BM, n = 647) or using peripheral blood (Haplo-PB, n = 949))
Comparison
One-antigen mismatched unrelated donor transplantation (1Ag-MMUD-PB, n = 155)
Outcome
Haplo-BM and Haplo-PB had a higher non-relapse mortality (NRM) compared to 1Ag-MMUD-PB (HR 2.28, 95% CI 1.23-4.24; HR 2.65, 95% CI 1.46-4.81, respectively). Haplo groups experienced a lower leukemia-free survival (LFS) compared to 1Ag-MMUD-PB (Haplo-BM: HR 1.51, 95% CI 1.06-2.14; Haplo-PB: 1.47, 95% CI 1.05-2.05); overall survival (OS) was also lower in Haplo-HCT (Haplo-BM: HR 1.50, 95% CI 1.02-2.21; Haplo-PB: HR 1.51, 95% CI 1.05-2.19). No differences were observed for graft-versus-host/relapse-free survival (GRFS) and relapse incidence (RI). Haplo-BM was associated with a lower risk of grade III-IV acute graft-versus-host disease (GVHD) (HR 0.44, 95% CI 0.24-0.81), while no statistical differences were observed between groups for grade II-IV aGVHD and for cGVHD.
3.
Single-Antigen-Mismatched Unrelated Hematopoietic Stem Cell Transplantation Using High-Dose Post-Transplantation Cyclophosphamide is a Suitable Alternative for Patients Lacking HLA-Matched Donors
Jorge, A. S., Suarez-Lledo, M., Pereira, A., Gutierrez, G., Fernandez-Aviles, F., Rosinol, L., Llobet, N., Solano, T., Urbano-Ispizua, A., Rovira, M., et al
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 2018
Abstract
The optimal prophylaxis regimen for graft-versus-host disease (GVHD) in the setting of mismatched unrelated donor (MMUD) allogeneic hematopoietic stem cell transplantation (alloSCT) is not defined. The use of high-dose post-transplant cyclophosphamide (PTCy) in haploidentical transplantation has proven feasible and effective in overcoming the negative impact of HLA-disparity on survival. We hypothesized that PTCy could also be effective in the setting of MMUD transplantation. We retrospectively analyzed 86 consecutive adult recipients of alloHSCT in our institution, comparing two contemporaneous groups: PTCyMMUD (n=26) vs. matched unrelated donor (MUD) (n=60). Graft source was primarily peripheral blood (92%). All PTCyMMUD were HLA 7/8 (differences in HLA-class I loci in 92% of patients), and received PTCy plus tacrolimus + mofetil mycophenolate as GVHD prophylaxis. No differences were observed between PTCyMMUD and MUD in the 100-day cumulative incidence of acute GVHD grades II-IV (31% vs. 22%, respectively, P=0.59) and III-IV (8% vs. 10%, P=0.67). There was a trend for a lower incidence of moderate/severe chronic GVHD at 1-year after PTCyMMUD in comparison with MUD (22% vs. 41%, P=0.098). No differences between PTCyMMUD and MUD were found regarding non-relapse mortality (25% vs. 18%; P=0.52) or relapse rate (11% vs. 19%, P=0.18). Progression-free survival and overall survival at 2-year were similar in both cohorts (67% vs. 54%, HR 0.84, 95% CI 0.38-1.88; P= 0.68; and 72% vs. 57%, HR 0.71; 95% CI 0.31-1.67; P=0.44, respectively). The 2-year cumulative incidence of survival free of moderate-severe chronic GVHD and relapse tended to be higher in the PTCyMMUD group (47% vs. 24%; HR 0.60, 95% CI 0.31-1.14, P=0.12). We conclude that HLA 7/8 MMUD transplantation using PTCy plus tacrolimus is a suitable alternative for those patients who lack a MUD.