AI Article Synopsis
- Allogeneic hematopoietic stem cell transplantation is the best treatment for high-risk or intermediate acute myeloid leukemia (AML), with matched sibling donors preferred over haploidentical donors.
- A study of 2,654 patients revealed that those receiving haploidentical transplants had worse outcomes, including lower leukemia-free and overall survival rates, especially in intermediate-risk AML patients.
- In high-risk patients, though there were no significant differences in survival, haploidentical transplants showed trends toward lower relapse rates but higher instances of graft-versus-host disease (GvHD).
Article Abstract
Allogeneic hematopoietic stem cell transplantation is the optimal care for patients with high-risk or intermediate - acute myeloid leukemia. In patients lacking matched sibling donor, haploidentical donors are an option. We compared outcomes of unmanipulated (Haplo) to matched sibling donor transplant in acute myeloid leukemia patients in first complete remission. Included were intermediate and high-risk acute myeloid leukemia in first complete remission undergoing Haplo and matched sibling donor transplant from 2007-2015, and reported to the ALWP of the EBMT. A propensity score technique was used to confirm results of main analysis: 2 matched sibling donors were matched with 1 Haplo. We identified 2654 pts (Haplo =185; matched sibling donor =2469), 2010 with intermediate acute myeloid leukemia (Haplo=122; matched sibling donor =1888) and 644 with high-risk acute myeloid leukemia (Haplo =63; matched sibling donor =581). Median follow up was 30 (range 1-116) months. In multivariate analysis, in intermediate - acute myeloid leukemia patients, Haplo resulted in lower leukemia-free survival (Hazard Ratio 1.74; <0.01), overall-survival (HR 1.80; <0.01) and GvHD-free-relapse-free survival (Hazard Ratio 1.32; <0.05) and higher graft--host disease (GvHD) non-relapse mortality (Hazard Ratio 3.03; <0.01) as compared to matched sibling donor. In high-risk acute myeloid leukemia, no differences were found in leukemia-free survival, overall-survival, and GvHD-free- relapse-free survival according to donor type. Higher grade II-IV acute GvHD was observed for Haplo in both high-risk (Hazard Ratio 2.20; <0.01) and intermediate risk (Hazard Ratio 1.84; <0.01). A trend for a lower Relapse-Incidence was observed in Haplo among high-risk acute myeloid leukemia (Hazard Ratio 0.56; =0.06). The propensity score analysis confirmed results. Our results underline that matched sibling donor is the first choice for acute myeloid leukemia patients in first complete remission. On the other hand, results of Haplo transplants are similar to matched sibling donor transplants in acute myeloid leukemia patients with high risk cytogenetics.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6068036 | PMC |
| http://dx.doi.org/10.3324/haematol.2018.189258 | DOI Listing |
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