Outcomes of hematopoietic stem cell transplantation from unmanipulated haploidentical versus matched sibling donor in patients with acute myeloid leukemia in first complete remission with intermediate or high-risk cytogenetics: a study from the Acute Leuk
Fiche publication
Date publication
mai 2018
Journal
Haematologica
Auteurs
Membres identifiés du Cancéropôle Est :
Pr DECONINCK Eric
Tous les auteurs :
Salvatore D, Labopin M, Ruggeri A, Battipaglia G, Ghavamzadeh A, Ciceri F, Blaise D, Arcese W, Socié G, Bourhis JH, Van Lint M, Bruno B, Huynh A, Santarone S, Deconinck E, Mohty M, Nagler A
Lien Pubmed
Résumé
Allogeneic hematopoietic stem cell transplantation is the optimal care for patients with high-risk or intermediate acute myeloid leukemia. In patients lacking matched sibling donor, haploidentical donors are an option. We compared outcomes of unmanipulated haploidentical to matched sibling donor transplant in acute myeloid leukemia patients in first complete remission. Included were int- and high-risk acute myeloid leukemia in first complete remission undergoing haploidentical and matched sibling donor transplant from 2007-2015 and reported to the ALWP of the EBMT. A propensity score technique was used to confirm results of main analysis: 2 matched sibling donor were matched with 1 haplo. We identified 2654 pts (haplo =185; matched sibling donor =2469), 2010 with intermediate- acute myeloid leukemia (haplo=122; matched sibling donor =1888) and 644 with high-risk acute myeloid leukemia (haplo =63; matched sibling donor =581). Median follow up was 30 (range 1-116) months. In multivariate analysis, in intermediate - acute myeloid leukemia patients, haplo resulted in lower leukemia-free-survival (Hazard Ratio 1.74; p<0.01), overall-survival (HR 1.80; p<0.01) and GVH-free-relapse-free-survival (Hazard Ratio 1.32; p<0.05) and higher non-relapse-mortality (Hazard Ratio 3.03; p<0.01) as compared to matched sibling donor. In high-risk acute myeloid leukemia, no differences were found in leukemia-free-sruvival, overall-survival and GVH-free-relapse-free-survival according to donor type. Higher grade II-IV acute graft versus host disease was observed for haplo in both high-risk (Hazard Ratio 2.20; p<0.01) and int-risk (Hazard Ratio 1.84; p<0.01). A trend for a lower Relapse-Incidence was observed in haplo among high-risk acute myeloid leukemia (Hazard Ratio 0.56; p=0.06). The propensity score analysis confirmed results. Our results underline that matched sibling donor is the first choice for acute myeloid leukemia patients in first complete remission. On the other hand, results of haplo transplants are similar to matched sibling donor transplants in acute myeloid leukemia patients with high risk cytogenetics.
Référence
Haematologica. 2018 May 10;: