Outcomes of haploidentical vs matched sibling transplantation for acute myeloid leukemia in first complete remission

作者：Armin Rashidi, Mehdi Hamadani, Mei‐Jie Zhang, Hai-Lin Wang, Hisham Abdel‐Azim, Mahmoud Deeb Aljurf, Amer Assal, Ashish R. Bajel, Asad Bashey, Minoo Battiwalla, Amer Beitinjaneh, Nelli Bejanyan, Vijaya Raj Bhatt, Javier Bolaños‐Meade, Michael Thomas Byrne, Jean‐Yves Cahn, Mitchell Stuart Cairo, Stefan Octavian Ciurea, Edward Alan Copelan, Corey S. Cutler, Andrew S. Daly, Miguel-Angel Diaz, Nosha Farhadfar, Robert Peter Gale, Siddhartha Ganguly, Michael Richard Grunwald, Theresa Hahn, Shahrukh Khurshid Hashmi, Gerhard Carl Hildebrandt, H. Kent Holland, Nasheed Mohammad Hossain, Christopher George Kanakry, Mohamed A. Kharfan‐Dabaja, Nandita Khera, Yener Koç, Hillard Michael Lazarus, Jong Wook Lee, Johan A. Maertens, Rodrigo Martino, Joseph P. McGuirk, Reinhold Munker, Hemant S. Murthy, Ryotaro Nakamura, Sunita Nathan, Taiga Nishihori, Neil David Palmisiano, Sagar S. Patel, Joseph Pidala, Rebecca Leah Olin, Richard F. Olsson, Betül Oran, Olle T.H. Ringdén, David Alan Rizzieri, Jacob M. Rowe, Mary Lynn Savoie, Kirk R. Schultz, Sachiko Seo, Brian C. Shaffer, Anurag Kumar Singh, Melhem Solh, Keith E Stockerl-Goldstein, Leo F. Verdonck, John L. Wagner, Edmund K. Waller, Marcos J. G. De Lima, Brenda M. Sandmaier, Mark Robert Litzow, Dan Weisdorf, Rizwan Romee, Wael Saber · 发表于：Blood Advances · 年份：2019 · DOI：10.1182/bloodadvances.2019000050 · 被引用次数：131 · 研究领域：Hematopoietic Stem Cell Transplantation、Acute Myeloid Leukemia Research、Acute Lymphoblastic Leukemia research

Abstract HLA-haploidentical hematopoietic cell transplantation (Haplo-HCT) using posttransplantation cyclophosphamide (PT-Cy) has improved donor availability. However, a matched sibling donor (MSD) is still considered the optimal donor. Using the Center for International Blood and Marrow Transplant Research database, we compared outcomes after Haplo-HCT vs MSD in patients with acute myeloid leukemia (AML) in first complete remission (CR1). Data from 1205 adult CR1 AML patients (2008-2015) were analyzed. A total of 336 patients underwent PT-Cy–based Haplo-HCT and 869 underwent MSD using calcineurin inhibitor–based graft-versus-host disease (GVHD) prophylaxis. The Haplo-HCT group included more reduced-intensity conditioning (65% vs 30%) and bone marrow grafts (62% vs 7%), consistent with current practice. In multivariable analysis, Haplo-HCT and MSD groups were not different with regard to overall survival (P = .15), leukemia-free survival (P = .50), nonrelapse mortality (P = .16), relapse (P = .90), or grade II-IV acute GVHD (P = .98). However, the Haplo-HCT group had a significantly lower rate of chronic GVHD (hazard ratio, 0.38; 95% confidence interval, 0.30-0.48; P < .001). Results of subgroup analyses by conditioning intensity and graft source suggested that the reduced incidence of chronic GVHD in Haplo-HCT is not limited to a specific graft source or conditioning intensity. Center effect and minimal residual disease–donor type interaction were not predictors of outcome. ...