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Hematopoietic stem cell transplantation with unrelated cord blood or haploidentical donor grafts in adult patients with secondary acute myeloid leukemia, a comparative study from Eurocord and the ALWP EBMT

Abstract

Survival of patients with secondary acute myeloid leukemia (sAML) is poor. Cord blood transplantation (UCBT) and non-T-cell-depleted stem cell transplantation from haploidentical donors (HAPLO) are both strategies that have shown encouraging results in patients who do not have an human leukocyte antigen (HLA)-matched sibling or unrelated donor. We retrospectively analyzed outcomes of 409 adults with sAML receiving either UCBT (n = 163) or HAPLO (n = 246) in EBMT centers. Myelodysplastic syndrome (MDS) or myeloproliferative disorder (MPD) was the antecedent diagnosis in 79% of UCBT and 85% of HAPLO recipients. In multivariate analysis, UCBT was associated with higher risk of grade II–IV acute GVHD (HR 1.9, p = 0.009) and lower GHVD-free-relapse-free-survival (GRFS) (HR 1.57, p = 0.007) compared to HAPLO. Chronic-GVHD, RI, NRM, LFS, and OS were not statistically different between the two. Early disease stage at transplant was independently associated with lower RI and NRM and higher OS and LFS. These results indicate that HAPLO is associated with better GRFS and lower aGvHD compared to UCBT in patients with sAML and that UCBT can be a valid alternative for sAML patients who lack a matched sibling, a proper haploidentical or an unrelated donor.

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Acknowledgements

The authors thank Emmanuelle Polge and Chantal Kenzey for helping with data collection and the association “Cordons de vie”, Monaco.

Author information

AR, ML, and AN designed the study. AR and AP wrote the paper. AR and ML performed the statistical analysis. AP and FV helped with data and manuscript preparation. BS, DB, FC, AB, JT, PC, YK, JJC, GS, ED, VR, FB, MM, EG provided cases for the study. All authors edited and approved the manuscript.

Correspondence to Annalisa Ruggeri.

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Conflict of interest

Frederic Baron has received travel grants from Celgene, Abbvie, Novartis and Sanofi. The remaining authors declare that they have no conflict of interest.

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