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Unmanipulated haploidentical versus HLA-matched sibling allogeneic hematopoietic stem cell transplantation in relapsed/refractory acute myeloid leukemia: a retrospective study on behalf of the ALWP of the EBMT

Bone Marrow Transplantation volume 54, pages 1499–1510 (2019)Cite this article

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Abstract

Refractory or relapsed acute myeloid leukemia (R/R-AML) has poor prognosis. Allogeneic hematopoietic stem-cell transplantation (HSCT) may provide cure in this scenario. We compared outcomes of HSCT from HLA-identical (HLA-id, n = 1654) sibling or haploidentical (Haplo, n = 389) donors in patients with R/R-AML, performed during the period 2007–2015. The Haplo group included patients receiving an unmanipulated graft (post-transplant cyclophosphamide, n = 278; in vivo T-cell depletion, n = 95; or both, n = 16). Median age at HSCT was 52 (range 18–74) years. Median follow-up was 16 and 22 months for HLA-id sibling and Haplo recipients, respectively (p = 0.11). Compared to MSD, Haplo HSCT were performed more recently (2013 vs 2011, p < 0.01), at longer interval from diagnosis (7 vs 5 months, p < 0.01), more frequently using bone marrow as stem cell source (47% vs 8%, p < 0.01) and with a reduced intensity conditioning regimen (50% vs 43%, p = 0.03). Engraftment was higher (93% vs 83%, p < 0.01) in HLA-id sibling. In multivariate analysis, Haplo HSCT was associated with lower GVHD/relapse-free survival, inferior LFS and OS and higher NRM, mainly due to a higher rate of infections (41% vs 25%, p < 0.01). For R/R-AML, HLA-id sibling donors remain the gold standard, when available, due to higher mortality in Haplo without significant gain in disease control.

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Acknowledgements

The authors thank Emmanuelle Polge from the office of the ALWP of EBMT.

Author contributions

GB, AR, and AN designed the study. AB and ML performed the statistical analysis. GB wrote the manuscript. AR and AN revised the manuscript and all the authors reviewed its final version. FC, JT, MS, Gem DB, JF, MTVL, AG, BA, RF, and MM were the principal investigators at the centers recruiting the highest number of patients for the study.

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Authors and Affiliations

  1. Hematology Department, Hôpital Saint Antoine, Service d’Hématologie et Thérapie Cellulaire, Paris, France

    Giorgia Battipaglia, Myriam Labopin & Mohamad Mohty

  2. Hematology Department, Federico II University, Naples, Italy

    Giorgia Battipaglia

  3. Acute Leukemia Working Party of EBMT, Paris, France

    Ariane Boumendil, Myriam Labopin, Mohamad Mohty & Arnon Nagler

  4. Hospital Saint-Antoine, Paris University UPMC, INSERM U938, Paris, France

    Myriam Labopin & Mohamad Mohty

  5. Hematology and BMT Unit, IRCCS Ospedale San Raffaele; University Vita-Salute San, Raffaele, Milano, Italy

    Fabio Ciceri

  6. Department of Internal Medicine III, University Hospital of Munich-Grosshadern, Ludwig-Maximilians University, Munich, Germany

    Johanna Tischer

  7. Department of Medicine / Hematology and Oncology, University of Muenster, Muenster, Germany

    Matthias Stelljes

  8. Universitaetsklinikum Dresden, Medizinische Klinik und Poliklinik I, Dresden, Germany

    Gerhard Ehninger

  9. Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital of Essen, Essen, Germany

    Dietrich Beelen

  10. University of Freiburg, Dept. of Medicine -Hematology, Oncology, Freiburg, Germany

    Jürgen Finke

  11. Ospedale San Martino, Department of Haematology II Genova, Genova, Italy

    Maria Teresa Van Lint

  12. Hannover Medical School, Department of Haematology, Hemostasis, Oncologyand Stem Cell Transplantation, Hannover, Germany

    Matthias Eder

  13. First State Pavlov Medical University of St. Petersburg, Lev Tolstoy St Petersburg, Russia

    Boris Afanasyev

  14. Azienda Ospedaliero Universitaria di Udine, Division of Hematology, Udine, Italy

    Renato Fanin

  15. Department of Pediatric Hematology and Oncology, IRCCS Bambino Gesù Children’s Hospital, Roma, Italy

    Annalisa Ruggeri

  16. Chaim Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel

    Arnon Nagler

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  1. Giorgia Battipaglia
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Correspondence to Giorgia Battipaglia.

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Battipaglia, G., Boumendil, A., Labopin, M. et al. Unmanipulated haploidentical versus HLA-matched sibling allogeneic hematopoietic stem cell transplantation in relapsed/refractory acute myeloid leukemia: a retrospective study on behalf of the ALWP of the EBMT. Bone Marrow Transplant 54, 1499–1510 (2019). https://doi.org/10.1038/s41409-019-0459-7

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