TY - JOUR
T1 - Impact of donor selection in adverse-risk AML undergoing hematopoietic cell transplantation
T2 - A study from the EBMT Acute Leukemia Working Party
AU - Villalba, Marta
AU - Ferhat, Allain Thibeault
AU - Gedde-Dahl, Tobias
AU - Socie, Gerard
AU - Huynh, Anne
AU - Blau, Igor Wolfgang
AU - Yakoub-Agha, Ibrahim
AU - Blaise, Didier
AU - Eder, Matthias
AU - Forcade, Edouard
AU - Fanin, Renato
AU - Passweg, Jakob
AU - Crawley, Charles
AU - Stelljes, Matthias
AU - Stölzel, Friedrich
AU - Kroeger, Nicolaus
AU - Sengeloev, Henrik
AU - Ceballos, Patrice
AU - Labussiere-Wallet, Helene
AU - Poiré, Xavier
AU - Esteve, Jordi
AU - Savani, Bipin
AU - Nagler, Arnon
AU - Piemontese, Simona
AU - Sanz, Jaime
AU - Mohty, Mohamad
AU - Ciceri, Fabio
N1 - Publisher Copyright:
© The Author(s), under exclusive licence to Springer Nature Limited 2025.
PY - 2025
Y1 - 2025
N2 - We evaluated the influence of donor type in 3006 adults with adverse-risk cytogenetic acute myeloid leukemia (AML) in first complete remission undergoing allogeneic hematopoietic cell transplantation (HCT). Donor types included matched sibling (MSD), matched unrelated (MUD), mismatched unrelated (MMUD), and haploidentical donors. At 2 years, leukemia-free survival, overall survival (OS), and graft-versus-host disease (GVHD)-free/relapse-free survival were 47%, 55%, and 36%. Compared with MSD, OS was inferior with MUD (HR 1.36; 95% CI, 1.1–1.67), MMUD (HR 1.4; 95% CI, 1.07–1.83), and haploidentical grafts (HR 1.33; 95% CI, 1.02–1.73). Haploidentical was associated with lower relapse risk (HR 0.72; 95% CI, 0.53–0.97), but higher non-relapse mortality (NRM) (HR 3.85; 95% CI, 2.44–6.08). All alternative donors showed higher rates of grade II–IV acute GVHD. In 702 patients receiving post-transplant cyclophosphamide (PTCy), survival differences attenuated. However, haploidentical and MMUD showed higher risk of grade III–IV acute GVHD (HR 2.61; 95% CI, 1.04–6.54 and HR 3.74; 95% CI, 1.14–12.24), and haploidentical had increased NRM (HR 3.22; 95% CI, 1.23–8.44), without significant relapse. Findings support safety of alternative donors and reinforce MSD as preferred choice in adverse-risk AML. PTCy mitigates but does not eliminate the risk of donor mismatch.
AB - We evaluated the influence of donor type in 3006 adults with adverse-risk cytogenetic acute myeloid leukemia (AML) in first complete remission undergoing allogeneic hematopoietic cell transplantation (HCT). Donor types included matched sibling (MSD), matched unrelated (MUD), mismatched unrelated (MMUD), and haploidentical donors. At 2 years, leukemia-free survival, overall survival (OS), and graft-versus-host disease (GVHD)-free/relapse-free survival were 47%, 55%, and 36%. Compared with MSD, OS was inferior with MUD (HR 1.36; 95% CI, 1.1–1.67), MMUD (HR 1.4; 95% CI, 1.07–1.83), and haploidentical grafts (HR 1.33; 95% CI, 1.02–1.73). Haploidentical was associated with lower relapse risk (HR 0.72; 95% CI, 0.53–0.97), but higher non-relapse mortality (NRM) (HR 3.85; 95% CI, 2.44–6.08). All alternative donors showed higher rates of grade II–IV acute GVHD. In 702 patients receiving post-transplant cyclophosphamide (PTCy), survival differences attenuated. However, haploidentical and MMUD showed higher risk of grade III–IV acute GVHD (HR 2.61; 95% CI, 1.04–6.54 and HR 3.74; 95% CI, 1.14–12.24), and haploidentical had increased NRM (HR 3.22; 95% CI, 1.23–8.44), without significant relapse. Findings support safety of alternative donors and reinforce MSD as preferred choice in adverse-risk AML. PTCy mitigates but does not eliminate the risk of donor mismatch.
UR - http://www.scopus.com/inward/record.url?scp=105023133725&partnerID=8YFLogxK
U2 - 10.1038/s41409-025-02751-7
DO - 10.1038/s41409-025-02751-7
M3 - Journal article
C2 - 41318843
AN - SCOPUS:105023133725
SN - 0268-3369
JO - Bone Marrow Transplantation
JF - Bone Marrow Transplantation
ER -