Outcomes of haploidentical vs matched sibling transplantation for acute myeloid leukemia in first complete remission

• Type of Material: Article
• Authors: Edmund Waller, Emory University; Armin Rashidi, University of Minnesota Twin Cities; Mehdi Hamadani, Medical College of Wisconsin; Mei-Jie Zhang, Medical College of Wisconsin; Hai-Lin Wang, Medical College of Wisconsin; Hisham Abdel-Azim, Keck School of Medicine of USC; Mahmoud Aljurf, King Faisal Specialist Hospital and Research Centre; Amer Assal, Columbia University Medical Center; Ashish Bajel, Royal Melbourne Hospital; Asad Bashey, Northside Hospital; Minoo Battiwalla, Sarah Cannon BMT Program; Amer M. Beitinjaneh, University of Miami; Nelli Bejanyan, Moffitt Cancer Center; Vijaya Raj Bhatt, University of Nebraska Medical Center; Javier Bolaños-Meade, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Michael Byrne, Vanderbilt University Medical Center; Jean Yves Cahn, Centre Hospitalier Universitaire de Grenoble; Mitchell Cairo, New York Medical College; Stefan Ciurea, University of Texas MD Anderson Cancer Center; Edward Copelan, Carolinas HealthCare System; Corey Cutler, Dana-Farber Cancer Institute; Andrew Daly, Tom Baker Cancer Centre; Miguel-Angel Diaz, Hospital Infantil Universitario Niño Jesus de Madrid; Nosha Farhadfar, University of Florida College of Medicine; Robert P. Gale, University of Miami; Siddhartha Ganguly, University of Kansas; Michael R. Grunwald, Carolinas HealthCare System; Theresa Hahn, Roswell Park Cancer Institute; Shahrukh Hashmi, King Faisal Specialist Hospital and Research Centre; Gerhard C. Hildebrandt, Moffitt Cancer Center
• Language: English
• Date: 2019-01-01
• Publisher: American Society of Hematology: Blood Advances
• Publication Version: Final Published Version
• Copyright Statement: © 2019 American Society of Hematology. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1182/bloodadvances.2019000050
• Title of Journal or Parent Work: Blood Advances
• ISSN: 2473-9529
• Volume: 3
• Issue: 12
• Start Page: 1826
• End Page: 1836
• Grant/Funding Information: The CIBMTR is also supported by Actinium Pharmaceuticals, Amgen, Amneal Biosciences, Angiocrine Bioscience, an anonymous donation to the Medical College of Wisconsin, Astellas Pharma US, Atara Biotherapeutics, Be the Match Foundation, bluebird bio, Bristol Myers Squibb Oncology, Celgene Corporation, Cerus Corporation, Chimerix, the Fred Hutchinson Cancer Research Center, Gamida Cell, Gilead Sciences, HistoGenetics, Immucor, Incyte Corporation, Janssen Scientific Affairs, Jazz Pharmaceuticals, Juno Therapeutics, Karyopharm Therapeutics, Kite Pharma, Medac, MedImmune, The Medical College of Wisconsin, Mediware, Merck & Co., Mesoblast, Meso Scale Diagnostics, Millennium, Miltenyi Biotec, the National Marrow Donor Program, Neovii Biotech NA, Novartis Pharmaceuticals Corporation, Otsuka Pharmaceutical (Japan), Patient-Centered Outcomes Research Institute, Pfizer, Pharmacyclics, PIRCHE, Sanofi Genzyme, Seattle Genetics, Shire, Spectrum Pharmaceuticals, St. Baldrick’s Foundation, Sunesis Pharmaceuticals, Swedish Orphan Biovitrum, Takeda Oncology, Telomere Diagnostics, and the University of Minnesota.; The CIBMTR is supported primarily by the National Institutes of Health (public health service grant/cooperative agreement 5U24CA076518 from the National Cancer Institute, National Heart, Lung, and Blood Institute, and National Institute of Allergy and Infectious Diseases and grant/cooperative agreement 4U10HL069294 from the National Heart, Lung, and Blood Institute and National Cancer Institute), the Health Resources and Services Administration/Department of Health and Human Services (contract HHSH250201200016C), and the Office of Naval Research (grants N00014-17-1-2388 and N0014-17-1-2850).
• Research Categories: Health Sciences, Oncology; Health Sciences, Medicine and Surgery

Abstract

HLA-haploidentical hematopoietic cell transplantation (Haplo-HCT) using posttransplantation cyclophosphamide (PT-Cy) has improved donor availability. However, a matched sibling donor (MSD) is still considered the optimal donor. Using the Center for International Blood and Marrow Transplant Research database, we compared outcomes after Haplo-HCT vs MSD in patients with acute myeloid leukemia (AML) in first complete remission (CR1). Data from 1205 adult CR1 AML patients (2008-2015) were analyzed. A total of 336 patients underwent PT-Cy–based Haplo-HCT and 869 underwent MSD using calcineurin inhibitor–based graft-versus-host disease (GVHD) prophylaxis. The Haplo-HCT group included more reduced-intensity conditioning (65% vs 30%) and bone marrow grafts (62% vs 7%), consistent with current practice. In multivariable analysis, Haplo-HCT and MSD groups were not different with regard to overall survival (P 5 .15), leukemia-free survival (P 5 .50), nonrelapse mortality (P 5 .16), relapse (P 5 .90), or grade II-IV acute GVHD (P 5 .98). However, the Haplo-HCT group had a significantly lower rate of chronic GVHD (hazard ratio, 0.38; 95% confidence interval, 0.30-0.48; P, .001). Results of subgroup analyses by conditioning intensity and graft source suggested that the reduced incidence of chronic GVHD in Haplo-HCT is not limited to a specific graft source or conditioning intensity. Center effect and minimal residual disease–donor type interaction were not predictors of outcome. Our results indicate a lower rate of chronic GVHD after PT-Cy–based Haplo-HCT vs MSD using calcineurin inhibitor–based GVHD prophylaxis, but similar other outcomes, in patients with AML in CR1. Haplo-HCT is a viable alternative to MSD in these patients.