Article
作者: Olin, Rebecca ; Hahn, Theresa ; Singh, Anurag ; De Lima, Marcos ; Verdonck, Leo F. ; Battiwalla, Minoo ; Assal, Amer ; Koc, Yener ; Byrne, Michael ; Bolaños-Meade, Javier ; Wang, Hai-Lin ; Abdel-Azim, Hisham ; Bhatt, Vijaya Raj ; Kharfan-Dabaja, Mohamed A. ; Bashey, Asad ; Kanakry, Christopher G. ; Ganguly, Siddhartha ; Daly, Andrew ; Cairo, Mitchell ; Olsson, Richard F. ; Patel, Sagar ; Shaffer, Brian C. ; Litzow, Mark ; McGuirk, Joseph ; Weisdorf, Dan ; Rashidi, Armin ; Nishihori, Taiga ; Holland, H. Kent ; Ringden, Olov ; Maertens, Johan ; Hildebrandt, Gerhard C. ; Lazarus, Hillard M. ; Hamadani, Mehdi ; Nathan, Sunita ; Solh, Melhem ; Bajel, Ashish ; Murthy, Hemant S. ; Diaz, Miguel-Angel ; Hashmi, Shahrukh ; Farhadfar, Nosha ; Palmisiano, Neil ; Lee, Jong-Wook ; Schultz, Kirk R. ; Gale, Robert P. ; Zhang, Mei-Jie ; Saber, Wael ; Waller, Edmund K. ; Martino, Rodrigo ; Beitinjaneh, Amer M. ; Seo, Sachiko ; Cutler, Corey ; Rowe, Jacob ; Munker, Reinhold ; Hossain, Nasheed ; Khera, Nandita ; Rizzieri, David ; Grunwald, Michael R. ; Aljurf, Mahmoud ; Pidala, Joseph ; Cahn, Jean-Yves ; Wagner, John ; Bejanyan, Nelli ; Oran, Betul ; Nakamura, Ryotaro ; Savoie, Mary Lynn ; Ciurea, Stefan ; Copelan, Edward ; Romee, Rizwan ; Stockerl-Goldstein, Keith ; Sandmaier, Brenda M.
AbstractHLA-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. Our results indicate a lower rate of chronic GVHD after PT-Cy–based Haplo-HCT vs MSD using calcineurin inhibitor–based GVHD prophylaxis, but similar other outcomes, in patients with AML in CR1. Haplo-HCT is a viable alternative to MSD in these patients.
