Comparison of Haploidentical Bone Marrow versus Matched Unrelated Donor Peripheral Blood Stem Cell Transplantation with Posttransplant Cyclophosphamide in Patients with Acute Leukemia

A. Nagler, M. Labopin, B. Dholaria*, E. Angelucci, B. Afanasyev, J.J. Cornelissen, S. Sica, E. Meijer, F. Ciceri, G. Van Gorkom, N. Kroger, H. Martin, P. Pioltelli, A. Risitano, J. Canaani, B.N. Savani, J. Sanz, M. Mohty

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

14 Citations (Web of Science)

Abstract

Purpose: Posttransplant cyclophosphamide (PTCy) is increasingly being utilized as a principle GvHD prophylaxis strategy in allogeneic hematopoietic cell transplantation (allo-HCT). A haploidentical (haplo) or matched unrelated donor (UD) is a valid option in the absence of a matched related donor.

Experimental Design: We compared the outcomes of patients with acute leukemia who underwent haplo bonemarrow (haplo-BM, N = 401) versus UD mobilized peripheral blood stem cells (UD-PB, N = 192) transplantation in the setting of PTCy.

Results: The median follow-up duration was 36 months in the haplo-BM group and 16.6 months in the UD-PB group, respectively (P < 0.01). Myeloablative conditioning was used in 64.6% and 42.7% of haplo-BM and UD-PB patients, respectively (P < 0.01). Cumulative incidence of neutrophil engraftment at day 30 was 87% in haplo-BM versus 94% in UD-PB, respectively (P = 0.21). In the multivariate analysis, the risk of grade 2-4 acute GvHD (HR = 0.53, P = 0.01) and chronic GvHD (HR = 0.50, P = 0.02) was significantly lower in the haplo-BM group compared with the UD-PB group. There was no significant difference between the study groups with respect to relapse incidence, nonrelapse mortality, leukemia-fee survival, overall survival, or GvHD-free and relapse-free survival.

Conclusions: The use of a haplo donor with a BM graft resulted in a lower incidence of GvHD compared with a UD-PB stem cell graft in the setting of PTCy for patients with acute leukemia. However, differences in GvHD did not translate into a difference in survival outcomes. Based upon these data, UD-PB or haplo-BM should be considered equally acceptable sources for allo-HCT.

Original languageEnglish
Pages (from-to)843-851
Number of pages9
JournalClinical Cancer Research
Volume27
Issue number3
DOIs
Publication statusPublished - 1 Feb 2021

Keywords

  • graft
  • gvhd
  • prevention
  • prophylaxis
  • survival
  • versus-host-disease
  • SURVIVAL
  • PROPHYLAXIS
  • PREVENTION
  • GRAFT
  • GVHD
  • VERSUS-HOST-DISEASE

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