Haploidentical transplantation is associated with better overall survival when compared to single cord blood transplantation

Thiotepa-busulfan-fludarabine (TBF) is a widely used conditioning regimen in single umbilical cord blood transplantation (SUCBT). More recently, it was introduced in the setting of non-T cell depleted haploidentical stem cell transplantation (NTD-Haplo). Whether TBF based conditioning provides addit...

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Detalles Bibliográficos
Autores: Giannotti, Federica, Labopin, Myriam|||0000-0003-4514-4748, Shouval, Roni, Sanz, Jaime|||0000-0001-6934-4619, Arcese, William, Angelucci, Emanuele, Malouf Sierra, Jorge|||0000-0001-5185-520X, Ribera, Jose-Maria|||0000-0003-1042-6024, Santarone, Stella, Benedetto, Bruno, Rambaldi, Alessandro|||0000-0002-3739-7502, Saccardi, Riccardo|||0000-0002-5763-5467, Blaise, Didier|||0000-0002-5684-9447, Carella, Michele Angelo, Rocha, Vanderson, Baron, Frederic|||0000-0002-2944-3812, Mohty, Mohamad|||0000-0002-7264-808X, Ruggeri, Annalisa|||0000-0002-7261-2765, Nagler, Arnon
Tipo de recurso: artículo
Fecha de publicación:2018
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:286923
Acceso en línea:https://ddd.uab.cat/record/286923
https://dx.doi.org/urn:doi:10.1186/s13045-018-0655-8
Access Level:acceso abierto
Palabra clave:Acute myeloid leukemia
Conditioning regimens
Haploidentical stem cell transplantation
Stem cell transplantation
Thiotepa-busulfan-fludarabine
Umbilical cord blood transplantation
Descripción
Sumario:Thiotepa-busulfan-fludarabine (TBF) is a widely used conditioning regimen in single umbilical cord blood transplantation (SUCBT). More recently, it was introduced in the setting of non-T cell depleted haploidentical stem cell transplantation (NTD-Haplo). Whether TBF based conditioning provides additional benefit in transplantation from a particular alternative donor type remains to be established. This was a retrospective study based on an international European registry. We compared outcomes of de-novo acute myeloid leukemia patients in complete remission receiving NTD-Haplo (n = 186) vs. SUCBT (n = 147) following myeloablative conditioning (MAC) with TBF. Median follow-up was 23 months. Treatment groups resembled in baseline characteristics. SUCBT was associated with delayed engraftment and higher graft failure. In multivariate analysis no statistically significant differences were observed between the two groups in terms of acute or chronic graft-versus-host disease (GvHD) (HR = 1.03, p = 0.92 or HR = 1.86, p = 0.21) and relapse incidence (HR = 0.8, p = 0.65). Non-relapse mortality (NRM) was significantly higher in SUCBT as compared to NTD-Haplo (HR = 2.63, p = 0.001); moreover, SUCBT did worse in terms of overall survival (HR = 2.18, p = 0.002), leukemia-free survival (HR = 1.94, p = 0.007), and GvHD relapse-free survival (HR = 2.38, p = 0.0002). Our results suggest that TBF-MAC might allow for a potent graft-versus-leukemia, regardless of the alternative donor type. Furthermore, in patients receiving TBF-MAC, survival with NTD-Haplo may be better compared to SUCBT due to decreased NRM.

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