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Open Access 01-12-2017 | Research

A comparison between allogeneic stem cell transplantation from unmanipulated haploidentical and unrelated donors in acute leukemia

Authors: Simona Piemontese, F. Ciceri, M. Labopin, W. Arcese, S. Kyrcz-Krzemien, S. Santarone, H. Huang, D. Beelen, N. C. Gorin, C. Craddock, Z. Gulbas, A. Bacigalupo, M. Mohty, A. Nagler, on behalf of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT)

Published in: Journal of Hematology & Oncology | Issue 1/2017

Abstract

Background

In the absence of a HLA-matched related or matched unrelated donor, allogeneic stem cell transplantation (allo-SCT) from mismatched unrelated donors or haploidentical donors are potential alternatives for patients with acute leukemia with an indication to allo-SCT. The objective of this study was to compare the outcome of allo-SCT from T cell-replete haploidentical (Haplo) versus matched (MUD 10/10) or mismatched unrelated donor at a single HLA-locus (MMUD 9/10) for patients with acute leukemia in remission.

Methods

Two hundred sixty-five adult patients with de novo acute leukemia in first or second remission that received a Haplo-SCT between January 2007 and December 2013 were compared with 2490 patients receiving a MUD 10/10 and 813 receiving a MMUD 9/10. Propensity score weighted analysis was conducted in order to control for disease risk imbalances between the groups.

Results

The weighted 3-year non-relapse mortality and relapse incidence were 29 and 30% for Haplo, 21 and 29% for MUD 10/10, and 29 and 25% for MMUD 9/10, respectively. The weighted 3-year leukemia-free survival (LFS) and overall survival (OS) were 41 and 46% for Haplo, 50 and 56% for MUD 10/10, and 46 and 48% for MMUD 9/10, respectively. Using weighted Cox model, both LFS and OS were significantly higher in transplants from MUD 10/10 compared from those in Haplo but not different between transplants from MMUD 9/10 and Haplo. The type of donor was not significantly associated with neither acute nor chronic graft-versus-host disease.

Conclusions

Patients with acute leukemia in remission have better outcomes if transplanted from a MUD 10/10. We did not find any significant difference in outcome between transplants from MMUD 9/10 and Haplo, suggesting that both can be equally used in the absence of a 10/10 MUD.

Key point 1

Better outcomes using fully (10/10) matched unrelated donor for allo-SCT in acute leukemia in remission.

Key point 2

Similar outcomes after allo-SCT from unmanipulated haploidentical graft or mismatched (9/10) unrelated donor in acute leukemia in remission.

Available only for authorised users

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Title: A comparison between allogeneic stem cell transplantation from unmanipulated haploidentical and unrelated donors in acute leukemia
Authors: Simona Piemontese
F. Ciceri
M. Labopin
W. Arcese
S. Kyrcz-Krzemien
S. Santarone
H. Huang
D. Beelen
N. C. Gorin
C. Craddock
Z. Gulbas
A. Bacigalupo
M. Mohty
A. Nagler
on behalf of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT)
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: Journal of Hematology & Oncology / Issue 1/2017
Electronic ISSN: 1756-8722
DOI: https://doi.org/10.1186/s13045-017-0394-2

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