Comparing transplant outcomes in ALL patients after haploidentical with PTCy or matched unrelated donor transplantation

Monzr M. Al Malki, Dongyun Yang, Myriam Labopin, Boris Afanasyev, Emanuele Angelucci, Asad Bashey, Gérard Socié, Amado Karduss-Urueta, Grzegorz Helbig, Martin Bornhauser, Riitta Niittyvuopio, Arnold Ganser, Fabio Ciceri, Arne Brecht, Yener Koc, Nelli Bejanyan, Francesca Ferraro, Partow Kebriaei, Sally Mokhtari, Armin GhobadiRyotaro Nakamura, Stephen J. Forman, Richard Champlin, Mohamad Mohty, Stefan O. Ciurea, Arnon Nagler

Research output: Contribution to journalArticle

Abstract

We compared outcomes of 1461 adult patients with acute lymphoblastic leukemia (ALL) receiving hematopoietic cell transplantation (HCT) from a haploidentical (n 5 487) or matched unrelated donor (MUD; n 5 974) between January 2005 and June 2018. Graft-versus-host disease (GVHD) prophylaxis was posttransplant cyclophosphamide (PTCy), calcineurin inhibitor (CNI), and mycophenolate mofetil (MMF) for haploidentical, and CNI with MMF or methotrexate with/without antithymoglobulin for MUDs. Haploidentical recipients were matched (1:2 ratio) with MUD controls for sex, conditioning intensity, disease stage, Philadelphia-chromosome status, and cytogenetic risk. In the myeloablative setting, day 128 neutrophil recovery was similar between haploidentical (87%) and MUD (88%) (P 5 .11). Corresponding rates after reduced-intensity conditioning (RIC) were 84% and 88% (P 5 .47). The 3-month incidence of grade II-IV acute GVHD (aGVHD) and 3-year chronic GVHD (cGVHD) was similar after haploidentical compared with MUD: myeloablative conditioning, 33% vs 34% (P 5 .46) for aGVHD and 29% vs 31% for cGVHD (P 5 .58); RIC, 31% vs 30% (P 5 .06) for aGVHD and 24% vs 29% for cGVHD (P 5 .86). Among patients receiving myeloablative regimens, 3-year probabilities of overall survival were 44% and 51% with haploidentical and MUD (P 5 .56). Corresponding rates after RIC were 43% and 42% (P 5 .6). In this large multicenter case-matched retrospective analysis, despite the limitations of a registry-based study (ie, unavailability of key elements such as minimal residual disease testing), our analysis indicated that outcomes of patients with ALL undergoing HCT from a haploidentical donor were comparable with 8 of 8 MUD transplantations.

Original languageEnglish
Pages (from-to)2073-2083
Number of pages11
JournalBlood Advances
Volume4
Issue number9
DOIs
StatePublished - May 12 2020
Externally publishedYes

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  • Cite this

    Al Malki, M. M., Yang, D., Labopin, M., Afanasyev, B., Angelucci, E., Bashey, A., Socié, G., Karduss-Urueta, A., Helbig, G., Bornhauser, M., Niittyvuopio, R., Ganser, A., Ciceri, F., Brecht, A., Koc, Y., Bejanyan, N., Ferraro, F., Kebriaei, P., Mokhtari, S., ... Nagler, A. (2020). Comparing transplant outcomes in ALL patients after haploidentical with PTCy or matched unrelated donor transplantation. Blood Advances, 4(9), 2073-2083. https://doi.org/10.1182/bloodadvances.2020001499