title: Haploidentical transplant with posttransplant cyclophosphamide vs matched unrelated donor transplant for acute myeloid leukemia.
abstract: We studied adults with acute myeloid leukemia (AML) after haploidentical (n = 192) and 8/8 HLA-matched unrelated donor (n = 1982) transplantation. Haploidentical recipients received calcineurin inhibitor (CNI), mycophenolate, and posttransplant cyclophosphamide for graft-versus-host disease (GVHD) prophylaxis; 104 patients received myeloablative and 88 received reduced intensity conditioning regimens. Matched unrelated donor transplant recipients received CNI with mycophenolate or methotrexate for GVHD prophylaxis; 1245 patients received myeloablative and 737 received reduced intensity conditioning regimens. In the myeloablative setting, day 30 neutrophil recovery was lower after haploidentical compared with matched unrelated donor transplants (90% vs 97%, P = .02). Corresponding rates after reduced intensity conditioning transplants were 93% and 96% (P = .25). In the myeloablative setting, 3-month acute grade 2-4 (16% vs 33%, P < .0001) and 3-year chronic GVHD (30% vs 53%, P < .0001) were lower after haploidentical compared with matched unrelated donor transplants. Similar differences were observed after reduced intensity conditioning transplants, 19% vs 28% (P = .05) and 34% vs 52% (P = .002). Among patients receiving myeloablative regimens, 3-year probabilities of overall survival were 45% (95% CI, 36-54) and 50% (95% CI, 47-53) after haploidentical and matched unrelated donor transplants (P = .38). Corresponding rates after reduced intensity conditioning transplants were 46% (95% CI, 35-56) and 44% (95% CI, 0.40-47) (P = .71). Although statistical power is limited, these data suggests that survival for patients with AML after haploidentical transplantation with posttransplant cyclophosphamide is comparable with matched unrelated donor transplantation.
authors.affiliation: Department of Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX;
authors.forename: Stefan O
authors.initials: SO
authors.lastname: Ciurea
authors.affiliation: Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI;
authors.forename: Mei-Jie
authors.initials: MJ
authors.lastname: Zhang
authors.affiliation: Department of Hematology, IRCCS Azienda Ospedaliera Universitaria (AOU) San Martino-IST, Genoa, Italy;
authors.forename: Andrea A
authors.initials: AA
authors.lastname: Bacigalupo
authors.affiliation: Department of Medicine, Northside Hospital, Atlanta, GA;
authors.forename: Asad
authors.initials: A
authors.lastname: Bashey
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA;
authors.forename: Frederick R
authors.initials: FR
authors.lastname: Appelbaum
authors.affiliation: Department of Medicine, University of Kansas Medical Center, Kansas City, KS;
authors.forename: Omar S
authors.initials: OS
authors.lastname: Aljitawi
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA;
authors.forename: Philippe
authors.initials: P
authors.lastname: Armand
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA;
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Antin
authors.affiliation: Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI;
authors.forename: Junfang
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Arthur C. James Cancer Hospital, Columbus, OH;
authors.forename: Steven M
authors.initials: SM
authors.lastname: Devine
authors.affiliation: Experimental Transplantation and Immunobiology, Experimental Transplantation and Immunology Branch, National Cancer Institute, Bethesda, MD;
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Fowler
authors.affiliation: Department of Medicine - Hematology, Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD;
authors.forename: Leo
authors.initials: L
authors.lastname: Luznik
authors.affiliation: Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA;
authors.forename: Ryotaro
authors.initials: R
authors.lastname: Nakamura
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA;
authors.forename: Paul V
authors.initials: PV
authors.lastname: O'Donnell
authors.affiliation: Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY;
authors.forename: Miguel-Angel
authors.initials: MA
authors.lastname: Perales
authors.affiliation: Department of Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX;
authors.forename: Sai Ravi
authors.initials: SR
authors.lastname: Pingali
authors.affiliation: Hematology-Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA;
authors.forename: David L
authors.initials: DL
authors.lastname: Porter
authors.affiliation: Department of Medical Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL;
authors.forename: Marcie R
authors.initials: MR
authors.lastname: Riches
authors.affiliation: Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden;
authors.forename: Olle T H
authors.initials: OT
authors.lastname: Ringdén
authors.affiliation: Churchill Hospital, Oxford, United Kingdom;
authors.forename: Vanderson
authors.initials: V
authors.lastname: Rocha
authors.affiliation: Division of Hematology and Oncology, Washington University School of Medicine, Saint Louis, MO; and.
authors.forename: Ravi
authors.initials: R
authors.lastname: Vij
authors.affiliation: Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, MN.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Weisdorf
authors.affiliation: Department of Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX;
authors.forename: Richard E
authors.initials: RE
authors.lastname: Champlin
authors.affiliation: Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI;
authors.forename: Mary M
authors.initials: MM
authors.lastname: Horowitz
authors.affiliation: Department of Medicine - Hematology, Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD;
authors.forename: Ephraim J
authors.initials: EJ
authors.lastname: Fuchs
authors.affiliation: Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI;
authors.forename: Mary
authors.initials: M
authors.lastname: Eapen
mesh_terms: D000328:Adult; D000368:Aged; D003520:Cyclophosphamide / Q000627:therapeutic use*; D005260:Female; D006086:Graft vs Host Disease / Q000517:prevention & control; D006680:HLA Antigens / Q000235:genetics; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D015470:Leukemia, Myeloid, Acute / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D014019:Tissue Donors; D019172:Transplantation Conditioning / Q000379:methods; D055815:Young Adult
chemical_list: D006680:HLA Antigens; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide