Haploidentical vs sibling, unrelated, or cord blood hematopoietic cell transplantation for acute lymphoblastic leukemia
Abstract
The role of haploidentical hematopoietic cell transplantation (HCT) using posttransplant cyclophosphamide (PTCy) for acute lymphoblastic leukemia (ALL) is being defined. We performed a retrospective, multivariable analysis comparing outcomes of HCT approaches by donor for adults with ALL in remission. The primary objective was to compare overall survival (OS) among haploidentical HCTs using PTCy and HLA-matched sibling donor (MSD), 8/8 HLA-matched unrelated donor (MUD), 7 /8 HLA-MUD, or umbilical cord blood (UCB) HCT. Comparing haploidentical HCT to MSD HCT, we found that OS, leukemia-free survival (LFS), nonrelapse mortality (NRM), relapse, and acute graft-versus-host disease (aGVHD) were not different but chronic GVHD (cGVHD) was higher in MSD HCT. Compared with MUD HCT, OS, LFS, and relapse were not different, but MUD HCT had increased NRM (hazard ratio [HR], 1.42; P = .02), grade 3 to 4 aGVHD (HR, 1.59; P = .005), and cGVHD. Compared with 7/8 UD HCT, LFS and relapse were not different, but 7/8 UD HCT had worse OS (HR, 1.38; P = .01) and increased NRM (HR, 2.13; P ≤ .001), grade 3 to 4 aGVHD (HR, 1.86; P = .003), and cGVHD (HR, 1.72; P ≤ .001). Compared with UCB HCT, late OS, late LFS, relapse, and cGVHD were not different but UCB HCT had worse early OS (≤18 months; HR, 1.93; P < .001), worse early LFS (HR, 1.40; P = .007) and increased incidences of NRM (HR, 2.08; P < .001) and grade 3 to 4 aGVHD (HR, 1.97; P < .001). Haploidentical HCT using PTCy showed no difference in survival but less GVHD compared with traditional MSD and MUD HCT and is the preferred alternative donor HCT option for adults with ALL in complete remission.
Document Details
- Document Type
- Pub Defense Publication
- Publication Date
- Jan 11, 2022
- Source ID
- 10.1182/bloodadvances.2021004916
Entities
People
- A. Samer Al-homsi
- Akshay Sharma
- Alberto Mussetti
- Asad Bashey
- Baldeep Wirk
- Biju George
- Bipin N Savani
- Brian D Friend
- Christopher Bredeson
- Christopher S Hourigan
- César O. Freytes
- Daniel J Weisdorf
- David I. Marks
- David Rizzieri
- Edmund K Waller
- Edward Copelan
- Fotios V Michelis
- Gerhard C Hildebrandt
- Hai-lin Wang
- Hannah Choe
- Hemant S. Murthy
- Hillard M Lazarus
- Hisham Abdel-azim
- Hongtao Liu
- Ibrahim Aldoss
- Jan Cerny
- Jane L. Liesveld
- Jean A. Yared
- Jean-yves Cahn
- Jong Wook Lee
- Joseph McGuirk
- Karen Ballen
- Lee Ann Baxter‐Lowe
- Leland Metheny Iii
- Lena Winestone
- Leo F. Verdonck
- Lori Muffly
- Mahmoud Aljurf
- Marcos de Lima
- Marjolein Van Der Poel
- Mark R Litzow
- Matthew D. Seftel
- Matthew J. Wieduwilt
- Maxwell M Krem
- Mei-jie Zhang
- Melhem Solh
- Michael R. Grunwald
- Miguel Angel Diaz Perez
- Mitchell S Cairo
- Mohamed A Kharfan-Dabaja
- Muhammad Bilal Abid
- Neil Palmisiano
- Nelson J Chao
- Noel Estrada-merly
- Nosha Farhadfar
- Olle Ringden
- Partow Kebriaei
- Rammurti T. Kamble
- Reinhold Munker
- Richard Olsson
- Robert Peter Gale
- Rodrigo Martino
- Ryan Cassaday
- Sachiko Seo
- Sagar Patel
- Saurabh Chhabra
- Shahinaz Gadalla
- Sherif M Badawy
- Siddhartha Ganguly
- Steven Gore
- Sunita Nathan
- Taiga Nishihori
- Ulrike Bacher
- Usama Gergis
- Vijaya Raj Bhatt
- Wael Saber
- Yoshihiro Inamoto
Organizations
- Ann & Robert H. Lurie Children's Hospital of Chicago
- Baylor College of Medicine
- Case Western Reserve University
- Catholic University of Korea
- Center for International Blood and Marrow Transplant Research
- Children's Hospital Los Angeles
- Christian Medical College Vellore
- City of Hope National Medical Center
- Dokkyo Medical University
- Duke University
- Emory University
- Grenoble Alpes University
- H. Lee Moffitt Cancer Center & Research Institute
- Hospital de Sant Pau
- Imperial College London
- Karolinska Institutet
- Levine Cancer Institute
- Maastricht University Medical Centre
- Mayo Clinic
- Medical College of Wisconsin
- National Cancer Center
- National Cancer Institute
- National Heart, Lung, and Blood Institute
- New York Medical College
- New York University
- Northwestern University
- Ohio State University
- Pennsylvania State University
- Rush University
- St. Jude Children's Research Hospital
- Stanford University
- The Ottawa Hospital
- Thomas Jefferson University
- UH Cleveland Medical Center
- University of Bern
- University of British Columbia
- University of California, San Francisco
- University of Chicago Medical Center
- University of Florida
- University of Kansas
- University of Kentucky
- University of Massachusetts
- University of Minnesota
- University of Nebraska–Lincoln
- University of Oklahoma
- University of Rochester
- University of Southern California
- University of Texas at Austin
- University of Utah
- University of Virginia
- University of Washington
- Uppsala University
- Vanderbilt University Medical Center
- Yale University