Post-Transplantation Cyclophosphamide After HLA Identical Compared to Haploidentical Donor Transplant in Acute Myeloid Leukemia: A Study on Behalf of GETH-TC

Post-transplantation cyclophosphamide (PTCY) effectively prevents graft-versus-host disease (GVHD) after unmanipulated HLA-haploidentical hematopoietic stem cell transplantation (HSCT) and achieves low rates of GVHD in HLA-identical transplantation. To compare the outcomes of haploidentical versus H...

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Autores: Bailén, R, Pascual-Cascón, MJ, Guerreiro, M, López-Corral, L, Chinea, A, Bermúdez, A, Sampol, A, Heras, I, García-Torres, E, Torres, M, Roca, JR, Herruzo, B, Sanz, J, Fonseca, M, Herrera, P, Colorado, M, Bento, L, López-Godino, O, Martín-Calvo, C, Fernández-Caldas, P, Marcos-Jubilar, M, Sánchez-Ortega, I, Solano, C, Noriega, V, Humala, K, Oarbeascoa, G, Díez-Martín, JL, Kwon, M
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2022
País:España
Institución:INCLIVA
Repositorio:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
OAI Identifier:oai:incliva.fundanetsuite.com:p19706
Acceso en línea:https://incliva.portalinvestigacion.com/publicaciones/19706
Access Level:acceso abierto
Palabra clave:GVHD prophylaxis
Post-transplantation
cyclophosphamide
Acute myeloid leukemia
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spelling Post-Transplantation Cyclophosphamide After HLA Identical Compared to Haploidentical Donor Transplant in Acute Myeloid Leukemia: A Study on Behalf of GETH-TCBailén, RPascual-Cascón, MJGuerreiro, MLópez-Corral, LChinea, ABermúdez, ASampol, AHeras, IGarcía-Torres, ETorres, MRoca, JRHerruzo, BSanz, JFonseca, MHerrera, PColorado, MBento, LLópez-Godino, OMartín-Calvo, CFernández-Caldas, PMarcos-Jubilar, MSánchez-Ortega, ISolano, CNoriega, VHumala, KOarbeascoa, GDíez-Martín, JLKwon, MGVHD prophylaxisPost-transplantationcyclophosphamideAcute myeloid leukemiaPost-transplantation cyclophosphamide (PTCY) effectively prevents graft-versus-host disease (GVHD) after unmanipulated HLA-haploidentical hematopoietic stem cell transplantation (HSCT) and achieves low rates of GVHD in HLA-identical transplantation. To compare the outcomes of haploidentical versus HLA identical HSCT in patients undergoing HSCT for acute myeloid leukemia (AML) using PTCY. We conducted a retrospective study of 229 patients undergoing first HSCT for AML using PTCY with additional immunosuppression, 99 from matched sibling or unrelated donor (MSD/MUD) performed in 3 hospitals and 130 from haploidentical donors (haplo group) performed in 20 hospitals within the Spanish Group of Hematopoietic Stem Cell Transplantation and Cellular Therapy. Peripheral blood stem cells were used as graft in 89% of patients; myeloablative conditioning was used in 56%. There were significantly more patients with active disease (5% versus 20%, P = .001), high/very high disease risk index (DRI) (32% versus 67%, P = .000) and prior auto-HSCT (2% versus 11%, P = .010) in the haplo group. Median follow-up was 27 and 62.5 months for MSD/MUD and haplo, respectively. At 2 years, no significant differences were observed in overall survival (OS) (72% versus 62%, P = .07), event-free survival (EFS) (70% versus 54%, P = .055), cumulative incidence of relapse (19% versus 25%, P = .13), non-relapse mortality (14% versus 19%, P = .145), and the composite endpoint of GVHD and relapse-free survival (49% versus 42%, P = .249). Multivariate analysis identified only age and active disease as significant risk factors for OS and EFS; reduced-intensity conditioning, high/very high DRI, and haplo donor were nearly statistically significant for these outcomes. Grade II-IV acute GVHD was lower in MSD/MUD (14% versus 47%, P = .000). Cumulative incidences of grade III-IV acute GVHD (4% versus 9%, P = .14) and moderate-severe chronic GVHD (22% versus 19%, P = .28) were similar. Limitations of our study include limited sample size, differences between haplo and MSD/MUD groups and heterogeneous additional immunosuppression and PTCY timing in MSD/MUD. The use of an HLA-identical donor with PTCY in patients with AML showed lower incidence of clinically significant grade II-IV acute GVHD compared to haplo donors. Further studies with larger sample sizes should be performed to establish a possible benefit of HLA-identical donor on survival. (C) 2022 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.ELSEVIER SCIENCE INC2022info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://incliva.portalinvestigacion.com/publicaciones/19706Transplantation and Cellular TherapyISSN: 26666375ISSNe: 26666367reponame:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVAinstname:INCLIVAInglésinfo:eu-repo/semantics/openAccessoai:incliva.fundanetsuite.com:p197062026-06-07T16:35:31Z
dc.title.none.fl_str_mv Post-Transplantation Cyclophosphamide After HLA Identical Compared to Haploidentical Donor Transplant in Acute Myeloid Leukemia: A Study on Behalf of GETH-TC
title Post-Transplantation Cyclophosphamide After HLA Identical Compared to Haploidentical Donor Transplant in Acute Myeloid Leukemia: A Study on Behalf of GETH-TC
spellingShingle Post-Transplantation Cyclophosphamide After HLA Identical Compared to Haploidentical Donor Transplant in Acute Myeloid Leukemia: A Study on Behalf of GETH-TC
Bailén, R
GVHD prophylaxis
Post-transplantation
cyclophosphamide
Acute myeloid leukemia
title_short Post-Transplantation Cyclophosphamide After HLA Identical Compared to Haploidentical Donor Transplant in Acute Myeloid Leukemia: A Study on Behalf of GETH-TC
title_full Post-Transplantation Cyclophosphamide After HLA Identical Compared to Haploidentical Donor Transplant in Acute Myeloid Leukemia: A Study on Behalf of GETH-TC
title_fullStr Post-Transplantation Cyclophosphamide After HLA Identical Compared to Haploidentical Donor Transplant in Acute Myeloid Leukemia: A Study on Behalf of GETH-TC
title_full_unstemmed Post-Transplantation Cyclophosphamide After HLA Identical Compared to Haploidentical Donor Transplant in Acute Myeloid Leukemia: A Study on Behalf of GETH-TC
title_sort Post-Transplantation Cyclophosphamide After HLA Identical Compared to Haploidentical Donor Transplant in Acute Myeloid Leukemia: A Study on Behalf of GETH-TC
dc.creator.none.fl_str_mv Bailén, R
Pascual-Cascón, MJ
Guerreiro, M
López-Corral, L
Chinea, A
Bermúdez, A
Sampol, A
Heras, I
García-Torres, E
Torres, M
Roca, JR
Herruzo, B
Sanz, J
Fonseca, M
Herrera, P
Colorado, M
Bento, L
López-Godino, O
Martín-Calvo, C
Fernández-Caldas, P
Marcos-Jubilar, M
Sánchez-Ortega, I
Solano, C
Noriega, V
Humala, K
Oarbeascoa, G
Díez-Martín, JL
Kwon, M
author Bailén, R
author_facet Bailén, R
Pascual-Cascón, MJ
Guerreiro, M
López-Corral, L
Chinea, A
Bermúdez, A
Sampol, A
Heras, I
García-Torres, E
Torres, M
Roca, JR
Herruzo, B
Sanz, J
Fonseca, M
Herrera, P
Colorado, M
Bento, L
López-Godino, O
Martín-Calvo, C
Fernández-Caldas, P
Marcos-Jubilar, M
Sánchez-Ortega, I
Solano, C
Noriega, V
Humala, K
Oarbeascoa, G
Díez-Martín, JL
Kwon, M
author_role author
author2 Pascual-Cascón, MJ
Guerreiro, M
López-Corral, L
Chinea, A
Bermúdez, A
Sampol, A
Heras, I
García-Torres, E
Torres, M
Roca, JR
Herruzo, B
Sanz, J
Fonseca, M
Herrera, P
Colorado, M
Bento, L
López-Godino, O
Martín-Calvo, C
Fernández-Caldas, P
Marcos-Jubilar, M
Sánchez-Ortega, I
Solano, C
Noriega, V
Humala, K
Oarbeascoa, G
Díez-Martín, JL
Kwon, M
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv GVHD prophylaxis
Post-transplantation
cyclophosphamide
Acute myeloid leukemia
topic GVHD prophylaxis
Post-transplantation
cyclophosphamide
Acute myeloid leukemia
description Post-transplantation cyclophosphamide (PTCY) effectively prevents graft-versus-host disease (GVHD) after unmanipulated HLA-haploidentical hematopoietic stem cell transplantation (HSCT) and achieves low rates of GVHD in HLA-identical transplantation. To compare the outcomes of haploidentical versus HLA identical HSCT in patients undergoing HSCT for acute myeloid leukemia (AML) using PTCY. We conducted a retrospective study of 229 patients undergoing first HSCT for AML using PTCY with additional immunosuppression, 99 from matched sibling or unrelated donor (MSD/MUD) performed in 3 hospitals and 130 from haploidentical donors (haplo group) performed in 20 hospitals within the Spanish Group of Hematopoietic Stem Cell Transplantation and Cellular Therapy. Peripheral blood stem cells were used as graft in 89% of patients; myeloablative conditioning was used in 56%. There were significantly more patients with active disease (5% versus 20%, P = .001), high/very high disease risk index (DRI) (32% versus 67%, P = .000) and prior auto-HSCT (2% versus 11%, P = .010) in the haplo group. Median follow-up was 27 and 62.5 months for MSD/MUD and haplo, respectively. At 2 years, no significant differences were observed in overall survival (OS) (72% versus 62%, P = .07), event-free survival (EFS) (70% versus 54%, P = .055), cumulative incidence of relapse (19% versus 25%, P = .13), non-relapse mortality (14% versus 19%, P = .145), and the composite endpoint of GVHD and relapse-free survival (49% versus 42%, P = .249). Multivariate analysis identified only age and active disease as significant risk factors for OS and EFS; reduced-intensity conditioning, high/very high DRI, and haplo donor were nearly statistically significant for these outcomes. Grade II-IV acute GVHD was lower in MSD/MUD (14% versus 47%, P = .000). Cumulative incidences of grade III-IV acute GVHD (4% versus 9%, P = .14) and moderate-severe chronic GVHD (22% versus 19%, P = .28) were similar. Limitations of our study include limited sample size, differences between haplo and MSD/MUD groups and heterogeneous additional immunosuppression and PTCY timing in MSD/MUD. The use of an HLA-identical donor with PTCY in patients with AML showed lower incidence of clinically significant grade II-IV acute GVHD compared to haplo donors. Further studies with larger sample sizes should be performed to establish a possible benefit of HLA-identical donor on survival. (C) 2022 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.
publishDate 2022
dc.date.none.fl_str_mv 2022
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://incliva.portalinvestigacion.com/publicaciones/19706
url https://incliva.portalinvestigacion.com/publicaciones/19706
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv ELSEVIER SCIENCE INC
publisher.none.fl_str_mv ELSEVIER SCIENCE INC
dc.source.none.fl_str_mv Transplantation and Cellular Therapy
ISSN: 26666375
ISSNe: 26666367
reponame:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
instname:INCLIVA
instname_str INCLIVA
reponame_str r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
collection r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
repository.name.fl_str_mv
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