Comparison of HLA-mismatched unrelated donor transplantation with post-transplant cyclophosphamide versus HLA-haploidentical transplantation in patients with active acute myeloid leukemia

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Baron, Frederic | Labopin, Myriam | Tischer, Johanna | Ciceri, Fabio | Raiola, Anna Maria | Blaise, Didier | Sica, Simona | Vydra, Jan | Fanin, Renato | Diez-Martin, Jose Luis | Bulabois, Claude Eric | Stolzel, Friedrich | Busca, Alessandro | Jindra, Pavel | Koc, Yener | Chevallier, Patrice | Forcade, Edouard | Roesler, Wolf | Passweg, Jakob | Kulagin, Alexander | Carella, Angelo Michele | Simand, Celestine | Bazarbachi, Ali | Pioltelli, Pietro | Nagler, Arnon | Mohty, Mohamad

Edité par CCSD ; Nature Publishing Group -

International audience. HLA-haploidentical allogeneic hematopoietic stem cell transplantation (Haplo-HCT) is frequently used as treatment for patients with active acute myeloid leukemia (AML). Here, we investigated whether 9/10 HLA-mismatched unrelated donor transplantation (MMUD-HCT) with post-transplant cyclophosphamide (PTCy) is an adequate alternative. Inclusion criteria in this retrospective registry study consisted of adult patients, first HCT with a Haplo donor or MMUD between 2010 and 2020 using PTCy as graft-versus-host disease (GVHD) prophylaxis, and primary refractory or relapsed disease. MMUD patients were pair-matched 1 to 2 with Haplo-recipients. A total of 73 MMUD patients met the inclusion criteria. Their data were compared to those of 146 Haplo patients in a matched-pair analysis. Median follow-up was 27 months in MMUD patients and 36 months in Haplo recipients. Two-year incidences of relapse and non-relapse mortality (NRM) were 40% and 18% in MMUD patients, respectively, versus 50% (P = 0.23) and 24% (P = 0.18) in Haplo recipients. Two-year leukemia-free survival (LFS) and overall survival (OS) was 42% and 46% in MMUD recipients, respectively, versus 26% (P = 0.1) and 28% (P = 0.061) in Haplo-patients. In conclusions, in AML patients with active disease at transplantation, MMUD-HCT results in at least comparable outcomes to Haplo-HCT when PTCy is applied. We report a paired-matched analysis of HLA-mismatched unrelated donor transplantation (MMUD, n = 73) versus HLA-haploidentical transplantation (n = 146) in AML patients with active disease at transplantation. Two-year leukemia-free survival and overall survival was 42% and 46% in MMUD recipients, respectively, versus 26% (P = 0.1) and 28% (P = 0.061) in Haplo-patients.

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