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Haplo-Cord transplantation compared to haploidentical transplantation with post-transplant cyclophosphamide in patients with AML

Bone Marrow Transplantation volume 52, pages 1138–1143 (2017)Cite this article

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Abstract

For patients with AML, the best alternative donor remains to be defined. We analyze outcomes of patients who underwent myeloablative umbilical cord blood or haploidentical hemopoietic stem cell transplantation (HSCT) in Spain. Fifty-one patients underwent single umbilical cord blood transplantation supported by a third party donor (Haplo-Cord) between 1999 and 2012, and 36 patients received an haploidentical HSCT with post-transplant cyclophosphamide (PTCY–haplo) between 2012 and 2014 in GETH centers. The Haplo-Cord cohort included a higher proportion of patients with high disease risk index and use of TBI in the conditioning regimen, and hematopoietic cell transplantation–age Comorbidity Age Index was higher in PTCY–haplo patients. Cumulative incidence of neutrophil engraftment was 97% in the Haplo-Cord and 100% in the PTCY–haplo group, achieved in a median of 12 and 17 days, respectively (P=0.01). Grade II–IV acute GvHD rate was significantly higher in the PTCY–haplo group (9.8% vs 29%, P=0.02) as well as chronic GvHD rates (20% vs 38%, P=0.03). With a median follow-up of 61 months for the Haplo-Cord group and 26 months for the PTCY–haplo cohort, overall survival at 2 years was 55% and 59% (P=0.66), event-free survival was 45% vs 56% (P=0.46), relapse rate was 27% vs 21% (P=0.79), and non-relapse mortality was 17% vs 23% (P=0.54), respectively. In this multicenter experience, Haplo-Cord and PTCY–haplo HSCT offer valid alternatives for patients with AML. Neutrophil engraftment was faster in the Haplo-Cord cohort, with similar survival rates, with higher GvHD rates after haploidentical HSCT.

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Acknowledgements

We thank the staff and nurses of all the hematology and transplant units for their care and contributions to making this work possible. We thank Jose Maria Bellón from the Instituto de Investigación Sanitaria Gregorio Marañon for data analysis. This work was partially supported by the Ministry of Economy and Competitiveness ISCIII-FIS grants PI08/1463, PI11/00708, PI14/01731 and RD12/0036/0061, co-financed by ERDF (FEDER) Funds from the European Commission, 'A way of making Europe', as well as grants from the Fundación LAIR, Asociación Madrileña de Hematología y Hemoterapia (AMHH) and Asociación Española Contra el Cáncer (AECC).

Author contributions

Conception and design: MK, GB, JG and PB.

Provision of study materials or patients: all authors.

Collection and assembly of data: MK, GB, JG and PB.

Data analysis and interpretation: all authors.

Manuscript writing: MK, GB and PB.

Final approval of the manuscript: all authors.

Author information

Authors and Affiliations

  1. Department of Hematology, Hospital General Universitario Gregorio Marañon, Madrid, Spain

    M Kwon, P Balsalobre, D Serrano, I Buño, J Anguita, J Gayoso & J L Diez-Martin

  2. Department of Hematology, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain

    M Kwon, P Balsalobre, D Serrano, I Buño, J Anguita, J Gayoso & J L Diez-Martin

  3. Department of Hematology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain

    G Bautista, A de Laiglesia, C Regidor, R Duarte & R Cabrera

  4. Department of Hematology, Hospital Duran i Reynals, Barcelona, Spain

    I Sánchez-Ortega

  5. Department of Hematology, Hospital U. La Fe, Valencia, Spain

    P Montesinos

  6. Department of Hematology, Hospital Universitario Marqués Valdecilla, Santander, Spain

    A Bermúdez

  7. Department of Hematology, Hospital Universitario Ramon y Cajal, Madrid, Spain

    P Herrera

  8. Department of Hematology, Hospital Universitario Reina Sofia, Córdoba, Spain

    C Martin

  9. Department of Hematology, Hospital Universitario La Paz, Madrid, Spain

    K Humala

  10. Department of Hematology, Complejo Hospitalario Navarra, Pamplona, Spain

    A Zabalza

  11. Department of Hematology, Hospital Universitario Gran Canaria Dr Negrin, Las Palmas, Spain

    M Torres

  12. Department of Hematology, Hospital Universitario Son Epases, Mallorca, Spain

    L Bento

  13. Department of Hematology, Hospital Clínico Universitario Salamanca, Murcia, Spain

    L L Corral

  14. Department of Hematology, Hospital General Universitario Morales Meseguer, Murcia, Spain

    I Heras

  15. Universidad Complutense de Madrid, Madrid, Spain

    J Gayoso & J L Diez-Martin

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  1. M Kwon
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  2. G Bautista
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on behalf of Grupo Español de Trasplante Hematopoyético y Terapia Celular (GETH)

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Correspondence to M Kwon.

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Kwon, M., Bautista, G., Balsalobre, P. et al. Haplo-Cord transplantation compared to haploidentical transplantation with post-transplant cyclophosphamide in patients with AML. Bone Marrow Transplant 52, 1138–1143 (2017). https://doi.org/10.1038/bmt.2017.36

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