A comparison between allogeneic stem cell transplantation from unmanipulated haploidentical and unrelated donors in acute leukemiaReportar como inadecuado

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1 San Raffaele Scientific Institute 2 EBMT - Centre International des greffes CHU Saint-Antoine 3 CR Saint-Antoine - Centre de Recherche Saint-Antoine 4 Università degli Studi di Roma Tor Vergata Roma 5 Silesian Medical University, Katowice, Poland 6 Università di Chieti-Pescara 7 Zhejiang University 8 University of Duisburg-Essen Essen 9 NQEH - BIRMINGHAM - New Queen Elizabeth Hospital 10 Anadolu University TURKEY 11 IRCCS - Istituto di Ricovero e Cura a Carattere Scientifico 12 Chaim Sheba Medical Center

Abstract : BackgroundIn the absence of a HLA-matched related or matched unrelated donor, allogeneic stem cell transplantation allo-SCT from mismatched unrelated donors or haploidentical donors are potential alternatives for patients with acute leukemia with an indication to allo-SCT. The objective of this study was to compare the outcome of allo-SCT from T cell-replete haploidentical Haplo versus matched MUD 10-10 or mismatched unrelated donor at a single HLA-locus MMUD 9-10 for patients with acute leukemia in remission.MethodsTwo hundred sixty-five adult patients with de novo acute leukemia in first or second remission that received a Haplo-SCT between January 2007 and December 2013 were compared with 2490 patients receiving a MUD 10-10 and 813 receiving a MMUD 9-10. Propensity score weighted analysis was conducted in order to control for disease risk imbalances between the groups.ResultsThe weighted 3-year non-relapse mortality and relapse incidence were 29 and 30% for Haplo, 21 and 29% for MUD 10-10, and 29 and 25% for MMUD 9-10, respectively. The weighted 3-year leukemia-free survival LFS and overall survival OS were 41 and 46% for Haplo, 50 and 56% for MUD 10-10, and 46 and 48% for MMUD 9-10, respectively. Using weighted Cox model, both LFS and OS were significantly higher in transplants from MUD 10-10 compared from those in Haplo but not different between transplants from MMUD 9-10 and Haplo. The type of donor was not significantly associated with neither acute nor chronic graft-versus-host disease.ConclusionsPatients with acute leukemia in remission have better outcomes if transplanted from a MUD 10-10. We did not find any significant difference in outcome between transplants from MMUD 9-10 and Haplo, suggesting that both can be equally used in the absence of a 10-10 MUD.

Autor: Simona Piemontese - F. Ciceri - M Labopin - W Arcese - S Kyrcz-Krzemien - S Santarone - He Huang - D Beelen - N.C Gorin - C Cradd

Fuente: https://hal.archives-ouvertes.fr/


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