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OUTCOMES OF NON T CELL-DEPLETED HAPLOIDENTICAL HSCT VERSUS HSCT FROM MATCHED SIBLING DONORS IN PATIENTS WITH ACUTE MYELOID LEUKEMIA IN FIRST COMPLETE REMISSION, AN ALWP-EBMT STUDY
Author(s):
Dalila Salvatore
,
Dalila Salvatore
Affiliations:
Hematology,Federico II,Naples,Italy
Myriam Labopin
,
Myriam Labopin
Affiliations:
Hematology Department,Service d'Hématologie et Thérapie Cellulaire,Hôpital Saint Antoine,Paris,France
Annalisa Ruggeri
,
Annalisa Ruggeri
Affiliations:
Hematology Department, Service d'Hématologie et Thérapie Cellulaire,Hôpital Saint Antoine,Paris,France
Giorgia Battipaglia
,
Giorgia Battipaglia
Affiliations:
Hematology Department, Service d'Hématologie et Thérapie Cellulaire,Hôpital Saint Antoine,Paris,France
Ardeshir Ghavamzadeh
,
Ardeshir Ghavamzadeh
Affiliations:
Hematology-Oncology and BMT Research,Shariati Hospital,Teheran,Iran, Islamic Republic Of
Fabio Ciceri
,
Fabio Ciceri
Affiliations:
Department of Hematology,Ospedale San Raffaele, Università degli Studi,Milano,Italy
Didier Blaise
,
Didier Blaise
Affiliations:
Programme de Transplantation&Therapie Cellulaire,Centre de Recherche en Cancérologie de Marseille,Institut PaoliCalmettes,Marseille,France
William Arcese
,
William Arcese
Affiliations:
Stem Cell Transplant Unit, Rome Transplant Network,Tor Vergata University Polyclinic, Tor Vergata University,Rome,Italy
Gerard Sociè
,
Gerard Sociè
Affiliations:
Dept.of Hematology - BMT,Hopital St. Louis,Paris,France
Maria Teresa Van Lint
,
Maria Teresa Van Lint
Affiliations:
Department of Haematology II,Hospital San Martino,Genova,Italy
Jean Henri Bourhis
,
Jean Henri Bourhis
Affiliations:
Department of Medical Oncology,Gustave Roussy, institut de cancérologie,BMT Service, Division of Hematology,Villejuif,France
Benedetto Bruno
,
Benedetto Bruno
Affiliations:
S.S.C.V.D Trapianto di Cellule Staminali,A.O.U Citta della Salute e della Scienza di Torino,Presidio Molinette,Torino,Italy
Anne Huynh
,
Anne Huynh
Affiliations:
Institut Universitaire du Cancer Toulouse,Oncopole I.U.C.T-O,Toulouse,France
Stella Santarone
,
Stella Santarone
Affiliations:
Department of Hematology,Bone Marrow Transplant Center, Transfusion Medicine and Biotechnology,Pescara,Italy
Eric Deconinck
,
Eric Deconinck
Affiliations:
Service d`Hématologie,Hopital Jean Minjoz,Besancon,France
Mohamad Mohty
,
Mohamad Mohty
Affiliations:
Hematology Department,Hôpital Saint Antoine, Service d'Hématologie et Thérapie Cellulaire,Paris,France
Arnon Nagler
Arnon Nagler
Affiliations:
Hematology Division,Chaim Sheba Medical Center,Tel Hashomer,Israel
(Abstract release date: 05/18/17) EHA Library. Salvatore D. 06/24/17; 181780; S493
Dalila Salvatore
Dalila Salvatore
Contributions
PDF Abstract
Abstract

Abstract: S493

Type: Oral Presentation

Presentation during EHA22: On Saturday, June 24, 2017 from 16:30 - 16:45

Location: Room N103

Background
Allogeneic hematopoietic stem cell transplantation (HSCT) is the standard of care for patients (pts) with intermediate (int-AML) or high-risk AML. In pts lacking matched sibling (MSD), HSCT from haploidentical donors (HAPLO) is an emerging option

Aims
The aim of the study was to compare outcomes of non T cell-depleted HAPLO HSCT to those from MSD

Methods
Included were adults with AML in first CR undergoing transplantation from HAPLO vs MSD from 2007-2015. Due to significant interaction between karyotype and donor type, int- and high-risk AML were studied separately. In addition because of some characteristic differences between the 2 groups the propensity score technique was used: 2 MSD were matched with each haplo. The following factors were included in the propensity score model: patient, year of HSCT, time from diagnosis to HSCT, conditioning (RIC), source of stem cells (BM/PB), cytogenetic group, patient and donor CMV serology status

Results

We identified 2654 pts (HAPLO=185; MSD=2469) for int-AML (HAPLO=122; MSD=1888) or high risk-AML (HAPLO=63; MSD=581). Median follow up was 30 (1-116) months. Median age at HSCT was 50 (18-74)years. Among HAPLO recipients, 74% received PTCY and 26% ATG. Conditioning regimen was myeloablative in 50% vs 52% (p=0.52) of HAPLO and MSD pts, respectively. HAPLO pts had a longer interval from diagnosis to HSCT (6 vs 4 months; p<0.01), had more often high risk-AML (34% vs 23%; p<0.01), bone marrow as stem cell source (49% vs 19%; p<0.01) and CMV positive donors (72% vs 61%; p<0.01). Graft failure occurred more frequently after HAPLO (3% vs 1%; p=0.002).For pts with int-AML CI of aGVHD and cGVHD was 29% vs 20% (p<0.03) and 30% vs 36% (p<0.02) in HAPLO and MSD pts, respectively. At two years, NRM and RI were 26% vs 10% (p<0.01) and 17% vs 20% (p=0.52) while LFS and OS were 56% vs 70% (p<0.01) and 68% vs 79% (p<0.01) in HAPLO and MSD pts, and GRFS was 45% vs 53% (p<0.05), respectively.
In multivariate analysis HAPLO was associated with reduced LFS (HR 1.74; 95% CI 1.30-2.33; p<0.01), OS (HR 1.80; 95% CI 1.32-2.45; p<0.01) and GRFS (HR 1.32; 95% CI 1.01-1.72; p<0.05) and higher NRM (HR 3.03; 95% CI 1.98-4.62; p<0.01). Incremental age was independently associated to lower LFS, OS, GRFS and higher NRM and cGVHD. MAC was associated with lower RI and higher GVHD. A female donor into male recipient was associated to higher GHVD and lower GRFS. A longer interval from diagnosis to HSCT was associated to lower LFS. Donor CMV seropositivity was associated with lower GRFS and higher NRM and aGVHD.
In high risk-AML aGVHD and cGVHD were 36% vs 24% (p=0.03) and 39% vs 33% (p=0.80) for HAPLO and MSD pts, respectively. At two years, NRM and RI were 18% vs 10% (p=0.16) and 21% vs 36% (p<0.02) while LFS and OS were 61% vs 55% (p=0.14) and 67% vs 66% (p=0.26) in HAPLO and MSD pts; GRFS was 49% vs 40% (p=0.17).
In multivariate analysis risk of grade II-IV aGVHD (HR: 2.20; 95% CI: 1.29-3.74; p<0.01) was increased after Haplo as compared to MSD and no difference was observed in LFS, OS and GRFS, respectively. Conditioning regimen was associated with lower NRM and higher GRFS, while younger age and donor CMV status were associated with lower RI, higher LFS and OS.
Results were confirmed in the analysis done with the the propensity score technique as for RI, NRM, LFS, OS and GRFS

Conclusion
As per our registry based study in intermediate risk AML results of HSCT from matched sibling donor are superior to those of HAPLO-HSCT, while in high risk-AML relapse is lower in the HAPLO transplants and NRM, LFS and OS is similar

Session topic: 22. Stem cell transplantation - Clinical

Keyword(s): Sibling, Haploidentical stem cell transplantation, Allogeneic hematopoietic stem cell transplant, Acute Myeloid Leukemia

Abstract: S493

Type: Oral Presentation

Presentation during EHA22: On Saturday, June 24, 2017 from 16:30 - 16:45

Location: Room N103

Background
Allogeneic hematopoietic stem cell transplantation (HSCT) is the standard of care for patients (pts) with intermediate (int-AML) or high-risk AML. In pts lacking matched sibling (MSD), HSCT from haploidentical donors (HAPLO) is an emerging option

Aims
The aim of the study was to compare outcomes of non T cell-depleted HAPLO HSCT to those from MSD

Methods
Included were adults with AML in first CR undergoing transplantation from HAPLO vs MSD from 2007-2015. Due to significant interaction between karyotype and donor type, int- and high-risk AML were studied separately. In addition because of some characteristic differences between the 2 groups the propensity score technique was used: 2 MSD were matched with each haplo. The following factors were included in the propensity score model: patient, year of HSCT, time from diagnosis to HSCT, conditioning (RIC), source of stem cells (BM/PB), cytogenetic group, patient and donor CMV serology status

Results

We identified 2654 pts (HAPLO=185; MSD=2469) for int-AML (HAPLO=122; MSD=1888) or high risk-AML (HAPLO=63; MSD=581). Median follow up was 30 (1-116) months. Median age at HSCT was 50 (18-74)years. Among HAPLO recipients, 74% received PTCY and 26% ATG. Conditioning regimen was myeloablative in 50% vs 52% (p=0.52) of HAPLO and MSD pts, respectively. HAPLO pts had a longer interval from diagnosis to HSCT (6 vs 4 months; p<0.01), had more often high risk-AML (34% vs 23%; p<0.01), bone marrow as stem cell source (49% vs 19%; p<0.01) and CMV positive donors (72% vs 61%; p<0.01). Graft failure occurred more frequently after HAPLO (3% vs 1%; p=0.002).For pts with int-AML CI of aGVHD and cGVHD was 29% vs 20% (p<0.03) and 30% vs 36% (p<0.02) in HAPLO and MSD pts, respectively. At two years, NRM and RI were 26% vs 10% (p<0.01) and 17% vs 20% (p=0.52) while LFS and OS were 56% vs 70% (p<0.01) and 68% vs 79% (p<0.01) in HAPLO and MSD pts, and GRFS was 45% vs 53% (p<0.05), respectively.
In multivariate analysis HAPLO was associated with reduced LFS (HR 1.74; 95% CI 1.30-2.33; p<0.01), OS (HR 1.80; 95% CI 1.32-2.45; p<0.01) and GRFS (HR 1.32; 95% CI 1.01-1.72; p<0.05) and higher NRM (HR 3.03; 95% CI 1.98-4.62; p<0.01). Incremental age was independently associated to lower LFS, OS, GRFS and higher NRM and cGVHD. MAC was associated with lower RI and higher GVHD. A female donor into male recipient was associated to higher GHVD and lower GRFS. A longer interval from diagnosis to HSCT was associated to lower LFS. Donor CMV seropositivity was associated with lower GRFS and higher NRM and aGVHD.
In high risk-AML aGVHD and cGVHD were 36% vs 24% (p=0.03) and 39% vs 33% (p=0.80) for HAPLO and MSD pts, respectively. At two years, NRM and RI were 18% vs 10% (p=0.16) and 21% vs 36% (p<0.02) while LFS and OS were 61% vs 55% (p=0.14) and 67% vs 66% (p=0.26) in HAPLO and MSD pts; GRFS was 49% vs 40% (p=0.17).
In multivariate analysis risk of grade II-IV aGVHD (HR: 2.20; 95% CI: 1.29-3.74; p<0.01) was increased after Haplo as compared to MSD and no difference was observed in LFS, OS and GRFS, respectively. Conditioning regimen was associated with lower NRM and higher GRFS, while younger age and donor CMV status were associated with lower RI, higher LFS and OS.
Results were confirmed in the analysis done with the the propensity score technique as for RI, NRM, LFS, OS and GRFS

Conclusion
As per our registry based study in intermediate risk AML results of HSCT from matched sibling donor are superior to those of HAPLO-HSCT, while in high risk-AML relapse is lower in the HAPLO transplants and NRM, LFS and OS is similar

Session topic: 22. Stem cell transplantation - Clinical

Keyword(s): Sibling, Haploidentical stem cell transplantation, Allogeneic hematopoietic stem cell transplant, Acute Myeloid Leukemia

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