Human leukocyte antigen-haploidentical transplantation for relapsed/refractory acute myeloid leukemia: Better leukemia-free survival with bone marrow than with peripheral blood stem cells in patients ≥55 years of age.
Adult
Bone Marrow
Bone Marrow Transplantation
/ adverse effects
Cyclophosphamide
/ therapeutic use
Graft vs Host Disease
/ etiology
HLA Antigens
/ genetics
Hematopoietic Stem Cell Transplantation
/ adverse effects
Humans
Leukemia, Myeloid, Acute
/ drug therapy
Peripheral Blood Stem Cell Transplantation
/ adverse effects
Peripheral Blood Stem Cells
Recurrence
Retrospective Studies
Transplantation Conditioning
/ methods
Transplantation, Haploidentical
/ adverse effects
Journal
American journal of hematology
ISSN: 1096-8652
Titre abrégé: Am J Hematol
Pays: United States
ID NLM: 7610369
Informations de publication
Date de publication:
08 2022
08 2022
Historique:
revised:
24
05
2022
received:
29
03
2022
accepted:
01
06
2022
pubmed:
14
6
2022
medline:
9
7
2022
entrez:
13
6
2022
Statut:
ppublish
Résumé
The best stem cell source for T-cell replete human leukocyte antigen (HLA)-haploidentical transplantation with post-transplant cyclophosphamide (PTCy) remains to be determined. In this European Society for Blood and Marrow Transplantation retrospective study, we analyzed the impact of stem cell source on leukemia-free survival (LFS) in adult patients with primary refractory or relapsed acute myeloid leukemia (AML) given grafts from HLA-haploidentical donors with PTCy as graft-versus-host disease (GVHD) prophylaxis. A total of 668 patients (249 bone marrow [BM] and 419 peripheral blood stem cells [PBSC] recipients) met the inclusion criteria. The use of PBSC was associated with a higher incidence of grade II-IV (HR = 1.59, p = .029) and grade III-IV (HR = 2.08, p = .013) acute GVHD. There was a statistical interaction between patient age and the impact of stem cell source for LFS (p < .01). In multivariate Cox models, among patients <55 years, the use of PBSC versus BM resulted in comparable LFS (HR = 0.82, p = .2). In contrast, in patients ≥55 years of age, the use of PBSC versus BM was associated with higher non-relapse mortality (NRM) (HR = 1.7, p = .01), lower LFS (HR = 1.37, p = .026) and lower overall survival (HR = 1.33, p = .044). In conclusions, our data suggest that in patients ≥55 years of age with active AML at HLA-haploidentical transplantation, the use of BM instead of PBSC as stem cell source results in lower NRM and better LFS. In contrast among younger patients, the use of PBSC results in at least a comparable LFS.
Substances chimiques
HLA Antigens
0
Cyclophosphamide
8N3DW7272P
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1065-1074Informations de copyright
© 2022 Wiley Periodicals LLC.
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