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Comparison of haploidentical hematopoietic stem cell transplantation with chemotherapy in older adults with acute myeloid leukemia

Bone Marrow Transplantation volume 58, pages 491–497 (2023)Cite this article

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Abstract

Acute myeloid leukemia (AML) outcomes are very poor in older patients. Haploidentical stem cell transplantation (haplo-SCT) helps to achieve long-term survival. However, the benefit of haplo-SCT versus chemotherapy is unclear in older adults with AML. Outcomes were retrospectively compared among patients aged 55‒65 years for chemotherapy consolidation or haplo-SCT for AML in the first complete remission with intermediate to high-risk disease. Forty-six patients who underwent chemotherapy and 38 patients who underwent haplo-SCT were evaluated in the final analysis. Compared with the chemotherapy group, patients in the haplo-SCT group had significantly better overall survival (OS) (74.0% versus 23.9% at 36 months, p = 0.005) and leukemia-free survival (LFS) (74.0% versus 21.6%, p < 0.001). The cumulative incidence of relapse (CIR) was significantly lower in the haplo-SCT group (17.3% versus 75.4%, p < 0.001). Treatment-related mortality (TRM) was similar in the haplo-SCT and chemotherapy groups (7.9% versus 4.8%, p = 0.587). In the multivariate analysis, haplo-SCT was associated with improved OS, LFS, and decreased CIR. Haplo-SCT did not affect TRM. In conclusion, our data suggest that haploidentical transplant may be an alternative to consolidation chemotherapy as post-remission therapy in patients with intermediate or high-risk AML aged 55‒65 years. Further well-designed studies are needed to validate this result.

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Fig. 1: Scheme of the present study.
Fig. 2: Comparison of haplo-SCT versus chemotherapy.

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Data availability

The data used to support the findings of this study are available from the corresponding author upon request.

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Acknowledgements

This work was partly supported by the National Natural Science Foundation of China (grant no. 8227010768) and the National Key Research and Development Program of China (2021YFC2500300).

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Authors and Affiliations

  1. Peking University People’s Hospital, Peking University Institute of Hematology, National Clinical Research Center for Treatment of Hematological Disease, Beijing, PR China

    Yu-Qian Sun, Xiao-Hui Zhang, Qian Jiang, Hao Jiang, Ying-Jun Chang, Yu Wang, Lan-Ping Xu, Kai-Yan Liu & Xiao-Jun Huang

  2. Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation for the Treatment of Hematological Diseases, Beijing, PR China

    Yu-Qian Sun, Xiao-Hui Zhang, Qian Jiang, Hao Jiang, Ying-Jun Chang, Yu Wang, Lan-Ping Xu, Kai-Yan Liu & Xiao-Jun Huang

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X-JH and Y-QS contributed to the study design, and Y-QS wrote the manuscript. In addition, all authors provided clinical or biological data and reviewed and approved the manuscript.

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Sun, YQ., Zhang, XH., Jiang, Q. et al. Comparison of haploidentical hematopoietic stem cell transplantation with chemotherapy in older adults with acute myeloid leukemia. Bone Marrow Transplant 58, 491–497 (2023). https://doi.org/10.1038/s41409-023-01925-5

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