Matched unrelated donor transplantation versus haploidentical transplantation with post-transplant cyclophosphamide in children with acute myeloid leukemia: a PDWP-EBMT study

Annalisa Ruggeri, Nicole Santoro, Jacques-Emmanuel Galimard, Krzysztof Kalwak, Mattia Algeri, Ludmila Zubarovskaya, Krzysztof Czyzewski, Elena Skorobogatova, Petr Sedlacek, Caroline Besley, Adriana Balduzzi, Yves Bertrand, Julia Peristeri, Franca Fagioli, Mariane Ifversen, Jolanta Gozdzik, Christina Peters, Birgitta Versluijs, Alessandra Biffi, Arcangelo PreteMaura Faraci, Ibrahim Ghemlas, Ivana Bodova, Olga Aleinikova, Arnaud Dalissier, Vanderson Rocha, Selim Corbacioglu

Abstract

In children with acute myeloid leukemia (AML) who lack an HLA identical sibling, the donor can be replaced with an HLA matched unrelated donor (MUD) or a haploidentical donor (haplo). We compared outcomes of patients <18 years with AML in first and second complete remission (CR1 and CR2) undergoing a hematopoietic stem cell transplantation (HCT) either with a MUD with anti-thymocyte globuline (ATG) (n=420) or a haplo HCT with PT-CY (n=96) after a myeloablative conditioning regimen (MAC) between 2011 and 2021, reported to EBMT. A matched pair analysis was performed to adjust for differences among groups. The final analysis was performed on 253 MUD and 95 haplo-HCTs. In the matched cohort, median age at HCT was 11.2 and 10 years and median year of HCT was 2017 and 2018, in MUD and haplo- HCT recipients, respectively. The risk of grade III-IV aGvHD was significantly higher in the haplo group (HR=2.33, 95%CI1.18-4.58, p=0.03). No significant differences were found in 2 years overall survival (OS; 78.4%vs71.5%; HR 1.39, 0.84-2.31, p=0.19), leukemia-free-survival (LFS; 72.7%vs69.5%; HR1.22, 0.76-1.95, p=0.41), CI of relapse (RI; 19.3%vs19.5%; HR=1.14, 0.62-2.08, p=0.68) non-relapse-mortality (NRM; 8%vs11%; HR=1.39, 0.66-2.93, p=0.39) and graft versus host free-relapse free survival (GRFS; 60.7%vs54.5%, HR=1.38, 0.95-2.02, p=0.09) after MUD and haplo-HCT respectively. Our study suggests that haplo-HCT with PT-CY is a suitable option to transplant children with AML lacking a matched related donor.

OriginalsprogEngelsk
TidsskriftHaematologica
ISSN0390-6078
DOI
StatusE-pub ahead of print - 4 jan. 2024

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