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Allogeneic stem cell transplantation for patients with acute myeloid leukemia (AML) in second complete remission (CR2) transplanted from unrelated donors with post-transplant cyclophosphamide (PTCy). A study on behalf of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation

Bone Marrow Transplantation volume 58, pages 552–557 (2023)Cite this article

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Abstract

Post-transplant cyclophosphamide (PTCy) is being increasingly used as graft-versus-host disease (GVHD) prophylaxis post allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with acute myeloid leukemia (AML) transplanted in first complete remission (CR1). However, results may differ in patients transplanted in CR2. We retrospectively evaluated transplant outcomes of adult AML patients transplanted between 2010–2019 from 9–10/10 human leukocyte antigen (HLA)-matched unrelated donor (UD) in CR2. In total, 127 patients were included (median age 45.5 years, 54% male). Median follow-up was 19.2 months. Conditioning was myeloablative (MAC) in 50.4% and the graft source was peripheral blood in 93.7% of the transplants. Incidence of acute (a)GVHD II-IV and III-IV was 26.2% and 9.2%. Two-year total and extensive chronic (c)GVHD were 34.3% and 13.8 %, respectively. Two-year non-relapse mortality (NRM), relapse incidence (RI), leukemia-free survival (LFS), overall survival (OS), and GVHD-free, relapse-free survival (GRFS) were 17.2%, 21.1%, 61.7, %, 65.2%, and 49.3%, respectively. Time from diagnosis to transplant (>18 months) was a favorable prognostic factor for RI, LFS, OS, and GRFS while favorable risk cytogenetics was a positive prognostic factor for OS. The patient’s age was a poor prognostic factor for NRM and cGVHD. Finally, the female-to-male combination and reduced intensity conditioning (RIC) were poor and favorable prognostic factors for cGVHD, respectively. We conclude that PTCy is an effective method for GVHD prophylaxis in AML patients undergoing allo-HCT in CR2 from UD.

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Fig. 1: Transplantation outcomes of allogeneic stem cell transplantation from an unrelated donor in patients with acute myeloid leukemia transplanted in second complete remission with post-transplant cyclophosphamide as anti-graft versus host disease prophylaxis.

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Professor Mohamad Mohty, and Dr Myriam Labopin from the ALWP will provide the data upon request.

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Acknowledgements

We thank all the EBMT centers and national registries for contributing patients to this study (see Appendix S1). We also thank the data managers for their excellent work.

Author information

Authors and Affiliations

  1. Division of Hematology, Sheba Medical Center, Tel Hashomer, Israel

    Arnon Nagler

  2. ALWP of the EBMT Paris office, Paris, France

    Myriam Labopin

  3. Sorbonne University, Department of Haematology, Saint Antoine Hospital, INSERM UMR 938, Paris, France

    Myriam Labopin

  4. Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland

    Ryszard Swoboda

  5. First State Pavlov Medical University of St. Petersburg, Raisa Gorbacheva Memorial Research Institute for Paediatric Oncology, Hematology, and Transplantation, St, Petersburg, Russia

    Alexander Kulagin

  6. Centre Hospitalier Lyon Sud, Pavillon Marcel Bérard, Service Hematologie, Lyon, France

    Hélène Labussière-Wallet

  7. Hospital Clinic, Department of Hematology, Institute of Hematology and Oncology, Barcelona, Spain

    Montserrat Rovira

  8. Programme de Transplantation & Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille; Institut Paoli Calmettes, Marseille, France

    Didier Blaise

  9. Institute of Hematology and Blood Transfusion, Prague, Czech Republic

    Jan Vydra

  10. CHU de Lille, Univ Lille, INSERM U1286, Infinite, 59000, Lille, France

    Ibrahim Yakoub-Agha

  11. Deptartment of Hematology; University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

    Goda Choi

  12. Dél-pesti Centrumkórház –Országos Hematológiai és Infektológiai Intézet; Dept. Haematology and Stem Cell Transplant, Albert, Budapest, Hungary

    Péter Reményi

  13. Medicana International Hospital Istanbul; Bone Marrow Transplant Unit, Istanbul, Turkey

    Yener Koc

  14. Hospital Universitari i Politècnic La Fe, Valencia, Spain

    Jaime Sanz

  15. Ospedale San Raffaele s.r.l. Haematology and BMT, Milano, Italy

    Fabio Ciceri

  16. Sorbonne University, Department of Clinical Hematology and Cellular Therapy, Hospital Saint Antoine, AP-HP, INSERM UMRs 938, Paris, France

    Mohamad Mohty

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Contributions

AN wrote the manuscript, designed the study, and interpreted the data. ML designed the study, performed the statistical analyses, interpreted the data, and edited the manuscript. MM designed the study, interpreted the data, and edited the manuscript. RS helped in writing the manuscript. AK, HLW, MR, DB, JV, IYA, GC, PR, YK, JS and FC reviewed the manuscript and provided clinical data. All authors approved the final version of the manuscript.

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Correspondence to Arnon Nagler.

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The scientific boards of the ALWP of the EBMT approved this study.

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Nagler, A., Labopin, M., Swoboda, R. et al. Allogeneic stem cell transplantation for patients with acute myeloid leukemia (AML) in second complete remission (CR2) transplanted from unrelated donors with post-transplant cyclophosphamide (PTCy). A study on behalf of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Bone Marrow Transplant 58, 552–557 (2023). https://doi.org/10.1038/s41409-023-01940-6

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