Annalisa Ruggeri1, Myriam Labopin1,2, Andrea Bacigalupo3, Zafer Gülbas4, Yener Koc5, Didier Blaise6, Benedetto Bruno7, Giuseppe Irrera8, Johanna Tischer9, Jose Luiz Diez-Martin10, Luca Castagna11, Fabio Ciceri12, Mohamad Mohty1,2,13, Arnon Nagler1,13,14. 1. Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France. 2. INSERM, UMRs 938, Paris, France. 3. Ospedale San Martino, Department of Hematology II, Genova, Italy. 4. Anadolu Medical Center Hospital, Bone Marrow Transplantation Department, Kocaeli, Turkey. 5. Medical Park Hospitals, Stem Cell Transplant Unit, Antalya, Turkey. 6. Programme de Transplantation & Therapie Cellulaire, Institut Paoli Calmettes, Marseille, France. 7. A.O.U Citta della Salute e della Scienza di Torino, Presidio Molinette, Torino, Italy. 8. Centro Unico Regionale Trapianti, Alberto Neri, Bianchi-Melacrino-Morelli, Reggio Calabria, Italy. 9. LMU-University Hospital of Munich-Grosshadern, Medizinischen Klinik III, Munich, Germany. 10. Instituto de Investigacion Sanitaria Gregorio Marañon, Division of Hematology, Hospital Gregorio Marañon, Universidad Complutense, Medicina, Madrid, Spain. 11. Department of Hematology, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy. 12. Ospedale San Raffaele, Haematology and BMT, Milano, Italy. 13. Université Pierre et Marie Curie, Paris, France. 14. Division of Hematology and Bone Marrow Transplantation, The Chaim Sheba Medical Center, Tel-Hashomer; Tel Aviv University, Tel Aviv, Israel.
Abstract
BACKGROUND: Incidence of graft-versus-host disease (GVHD) in haploidentical bone marrow (BM) transplants using posttransplantion cyclophosphamide (PT-Cy) is low, whereas GVHD using mobilized peripheral blood stem cells (PBSC) ranges between 30% and 40%. METHODS: To evaluate the effect of stem cell source in haploidentical transplantation with PT-Cy, we analyzed 451 patients transplanted for acute myeloid leukemia or acute lymphoblastic leukemia reported to the European Society for Blood and Marrow Transplantation. RESULTS: BM was used in 260 patients, and PBSC were used in 191 patients. The median follow-up was 21 months. Engraftment was lower in BM (92% vs 95%, P < 0.001). BM was associated with a lower incidence of stage II-IV and stage III-IV acute GVHD (21% vs 38%, P ≤ .01; and 4% vs 14%, P < .01, respectively). No difference in chronic GVHD, relapse, or nonrelapse mortality were found for PBSC or BM. The 2-year overall survival (OS) was 55% versus 56% (P = .57) and leukemia-free survival (LFS) was 49% versus 54% (P = .74) for BM and PBSC, respectively. On multivariate analysis, PBSC were associated with an increased risk of stage II-IV (hazard ratio [HR], 2.1; P < .001) and stage III-IV acute GVHD (HR, 3.8; P < .001). For LFS and OS, reduced intensity conditioning was the only factor associated with treatment failure (LFS: HR, 1.40; P = .04) and relapse (HR, 1.62; P = .02). CONCLUSION: In patients with acute leukemia in first or second remission receiving haploidentical transplantation with PT-Cy, the use of PBSC increases the risk of acute GVHD, whereas survival outcomes are comparable. Cancer 2018;124:1428-37.
BACKGROUND: Incidence of graft-versus-host disease (GVHD) in haploidentical bone marrow (BM) transplants using posttransplantion cyclophosphamide (PT-Cy) is low, whereas GVHD using mobilized peripheral blood stem cells (PBSC) ranges between 30% and 40%. METHODS: To evaluate the effect of stem cell source in haploidentical transplantation with PT-Cy, we analyzed 451 patients transplanted for acute myeloid leukemia or acute lymphoblastic leukemia reported to the European Society for Blood and Marrow Transplantation. RESULTS: BM was used in 260 patients, and PBSC were used in 191 patients. The median follow-up was 21 months. Engraftment was lower in BM (92% vs 95%, P < 0.001). BM was associated with a lower incidence of stage II-IV and stage III-IV acute GVHD (21% vs 38%, P ≤ .01; and 4% vs 14%, P < .01, respectively). No difference in chronic GVHD, relapse, or nonrelapse mortality were found for PBSC or BM. The 2-year overall survival (OS) was 55% versus 56% (P = .57) and leukemia-free survival (LFS) was 49% versus 54% (P = .74) for BM and PBSC, respectively. On multivariate analysis, PBSC were associated with an increased risk of stage II-IV (hazard ratio [HR], 2.1; P < .001) and stage III-IV acute GVHD (HR, 3.8; P < .001). For LFS and OS, reduced intensity conditioning was the only factor associated with treatment failure (LFS: HR, 1.40; P = .04) and relapse (HR, 1.62; P = .02). CONCLUSION: In patients with acute leukemia in first or second remission receiving haploidentical transplantation with PT-Cy, the use of PBSC increases the risk of acute GVHD, whereas survival outcomes are comparable. Cancer 2018;124:1428-37.
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