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Impact of donor kinship on non-T-cell depleted haploidentical stem cell transplantation with post transplantation cyclophosphamide for acute leukemia: From the ALWP of the EBMT

Abstract

Non-T-cell depleted haploidentical hematopoietic cell transplantation (Haplo-HCT) is a unique transplantation setting in which several donors are available. We assessed the impact of donor kinship on outcome of Haplo-HCT with post-transplantation cyclophosphamide in a cohort of 717 acute leukemia patients. We compared sibling with parent donors in patients ≤45 years, and child with sibling donors in patients >45 years. Donor kinship was not associated with worse outcomes in multivariate analysis. For patients ≤45 years, the hazard ratio (HR) for leukemia-free survival (LFS), overall survival (OS), relapse incidence (RI), and chronic graft-versus-host disease (cGVHD) was 0.87 (p = 0.75), 1.19 (p = 0.7), 0.52 (p = 0.19), and 0.99 (p = 0.97) for parents versus siblings, respectively, and for patients >45 years the HR was 0.93 (p = 0.8), 0.98 (p = 0.94), 1.3 (p = 0.53), and 0.98 (p = 0.95) for children versus siblings, respectively. Univariate incidence of acute GVHD grade II-IV was significantly higher in patients transplanted from siblings versus children (p = 0.002). Factors associated with inferior outcome were advanced disease and earlier transplant. In patients ≤45 years, acute lymphocytic leukemia and peripheral blood stem cell graft were additional prognostic factors for OS. We did not find a significant impact of donor kinship on transplantation outcome when analyzing by age group (≤45 and >45 years).

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Fig. 1: High correlation between patient age, donor age and patient/donor kinship.

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Acknowledgements

We thank the data managers of the EBMT/ALWP, the participating EBMT centers, and the patients.

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ID was responsible for designing the protocol, analyzing data, interpreting results, and writing the paper. CP, ML was responsible for analyzing the data and performing the study statistics. EP, JT, DB, YK, ZG, FC, MA, LC, BB, EA, NM, BNS, and SP contributed patients to the study and provided feedback and comments on the manuscript. AR helped in designing the protocol and writing the manuscript. MM, AN contributed to the design and review of the protocol, writing the report, extracting and analyzing data, interpreting results, and updating reference lists.

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Correspondence to Ivetta Danylesko.

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Danylesko, I., Peczynski, C., Labopin, M. et al. Impact of donor kinship on non-T-cell depleted haploidentical stem cell transplantation with post transplantation cyclophosphamide for acute leukemia: From the ALWP of the EBMT. Bone Marrow Transplant 57, 1260–1268 (2022). https://doi.org/10.1038/s41409-022-01695-6

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