title: T-cell-replete haploidentical transplantation versus autologous stem cell transplantation in adult acute leukemia: a matched pair analysis.
abstract: Adult patients with acute leukemia in need of a transplant but without a genoidentical donor are usually considered upfront for transplantation with stem cells from any other allogeneic source, rather than autologous stem cell transplantation. We used data from the European Society for Blood and Marrow Transplantation and performed a matched pair analysis on 188 T-cell-replete haploidentical and 356 autologous transplants done from January 2007 to December 2012, using age, diagnosis, disease status, cytogenetics, and interval from diagnosis to transplant as matching factors. "Haploidentical expert" centers were defined as having reported more than five haploidentical transplants for acute leukemia (median value for the study period). The median follow-up was 28 months. Multivariate analyses, including type of transplant categorized into three classes ("haploidentical regular", "haploidentical expert" and autologous), conditioning intensity (reduced intensity versus myeloablative conditioning) and the random effect taking into account associations related to matching, showed that non-relapse mortality was higher following haploidentical transplants in expert (HR: 4.7; P=0.00004) and regular (HR: 8.98; P<10(-5)) centers. Relapse incidence for haploidentical transplants was lower in expert centers (HR:0.39; P=0.0003) but in regular centers was similar to that for autologous transplants. Leukemia-free survival and overall survival rates were higher following autologous transplantation than haploidentical transplants in regular centers (HR: 1.63; P=0.008 and HR: 2.31; P=0.0002 respectively) but similar to those following haploidentical transplants in expert centers. We conclude that autologous stem cell transplantation should presently be considered as a possible alternative to haploidentical transplantation in regular centers that have not developed a specific expert program.
authors: APHP, Acute Leukemia Working Party-EBMT and Department of Hematology and Cell Therapy, Höpital Saint-Antoine, Paris, France Sorbonne Universités, UPMC University Paris 06, France INSERM UMR-S 938, Paris, France norbert-claude.gorin@sat.aphp.fr.
authors: Norbert-Claude
authors: NC
authors: Gorin
authors: APHP, Acute Leukemia Working Party-EBMT and Department of Hematology and Cell Therapy, Höpital Saint-Antoine, Paris, France Sorbonne Universités, UPMC University Paris 06, France INSERM UMR-S 938, Paris, France.
authors: Myriam
authors: M
authors: Labopin
authors: APHP, Acute Leukemia Working Party-EBMT and Department of Hematology and Cell Therapy, Höpital Saint-Antoine, Paris, France Ospedale San Raffaele s.r.l. Via Olgettina 60, Milan, Italy.
authors: Simona
authors: S
authors: Piemontese
authors: Rome Transplant Network, Tor Vergata University of Rome, Stem Cell Transplant Unit, Policlinico Universitario Tor Vergata, Rome, Italy.
authors: William
authors: W
authors: Arcese
authors: Ospedale Civile, Department of Hematology, Fonte Romana 8, Pescara, Italy.
authors: Stella
authors: S
authors: Santarone
authors: First Affiliated Hospital, Zhejiang University, Bone Marrow Transplantation Center, Hangzhou Zhejiang, China.
authors: He
authors: H
authors: Huang
authors: University La Sapienza, Rome, Italy.
authors: Giovanna
authors: G
authors: Meloni
authors: Cardarelli Hospital, Napoli, Italy.
authors: Felicetto
authors: F
authors: Ferrara
authors: University Hospital, Dept. of Bone Marrow Transplantation, Essen, Germany.
authors: Dietrich
authors: D
authors: Beelen
authors: Hospital Universitario La Fe, University of Valencia, Spain.
authors: Miguel
authors: M
authors: Sanz
authors: Ospedale San Martino, Department of Haematology II, Genova, Italy.
authors: Andrea
authors: A
authors: Bacigalupo
authors: Ospedale San Raffaele s.r.l. Via Olgettina 60, Milan, Italy.
authors: Fabio
authors: F
authors: Ciceri
authors: APHP, Acute Leukemia Working Party-EBMT and Department of Hematology and Cell Therapy, Höpital Saint-Antoine, Paris, France.
authors: Audrey
authors: A
authors: Mailhol
authors: Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors: Arnon
authors: A
authors: Nagler
authors: APHP, Acute Leukemia Working Party-EBMT and Department of Hematology and Cell Therapy, Höpital Saint-Antoine, Paris, France Sorbonne Universités, UPMC University Paris 06, France INSERM UMR-S 938, Paris, France.
authors: Mohamad
authors: M
authors: Mohty
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000209:etiology / Q000517:prevention & control; D006239:Haplotypes; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007938:Leukemia / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008212:Lymphocyte Depletion; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D016019:Survival Analysis; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
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