title: Is there a stronger graft-versus-leukemia effect using HLA-haploidentical donors compared with HLA-identical siblings?
abstract: Haploidentical hematopoietic stem cell transplants (HSCTs) are increasingly used, but it is unknown whether they have a stronger graft-versus-leukemia (GVL) effect. We analyzed 10 679 acute leukemia patients who underwent HSCT from an HLA-matched sibling donor (MSD, n=9815) or a haploidentical donor (⩾2 HLA-antigen disparity, n=864) between 2007 and 2012, reported to the European Group for Blood and Marrow Transplantation. In a Cox regression model, acute and chronic graft-versus-host disease (GVHD) was added as time-dependent variables. There was no difference in probability of relapse between recipients of haploidentical and MSD grafts. Factors of importance for relapse after T-cell-replete grafts included remission status at HSCT, Karnofsky score ⩽80, acute GVHD of grade II or higher and chronic GVHD (P<10(-5)). Patients with post-transplant cyclophosphamide (n=194) had similar outcome as other T-cell-replete haploidentical transplants (n=369). Non-relapse mortality was significantly higher in the haploidentical group compared with that in MSD patients (P<10(-5)). Leukemia-free survival was superior in the MSD patients receiving T-cell-replete (P<10(-5)) or T-cell-depleted grafts (P=0.0006). The risk of relapse was the same in acute leukemia patients who received haploidentical donor grafts as in those given MSD transplants, suggesting a similar GVL effect.
authors: Division of Therapeutic Immunology, F79, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.
authors: O
authors: O
authors: Ringdén
authors: EBMT-ALWP Office and University Pierre and Marie Curie, Department of Hematology, Hospital Saint Antoine, Paris, France.
authors: M
authors: M
authors: Labopin
authors: Hospital San Raffaele, Milano, Italy.
authors: F
authors: F
authors: Ciceri
authors: Sezione di Ematologia, Dipartimento di Medicina Clinical e Sperimentale, Università di Perugia Ospedale Santa Maria della Misericordia, Perugia, Italy.
authors: A
authors: A
authors: Velardi
authors: Ospedale San Martino, Department of Haematology II, Genova, Italy.
authors: A
authors: A
authors: Bacigalupo
authors: Rome Transplant Network, 'Tor Vergata' University of Rome, Stem Cell Transplant Unit Policlinico Universitario Tor Vergata, Rome, Italy.
authors: W
authors: W
authors: Arcese
authors: Tehran University of Medical Sciences, Shariati Hospital Hematology, Oncology and BMT Research Center, Tehran, Iran.
authors: A
authors: A
authors: Ghavamzadeh
authors: Centre Pierre et Marie Curie, Service Hématologie Greffe de Moëlle, Alger, Algeria.
authors: R M
authors: RM
authors: Hamladji
authors: II Medizinische Klinik, Klinikum Augsburg, Augsburg, Germany.
authors: C
authors: C
authors: Schmid
authors: EBMT-ALWP Office and University Pierre and Marie Curie, Department of Hematology, Hospital Saint Antoine, Paris, France.|Chaim Sheba Medical Center, Tel-Hashomer, Israel.
authors: A
authors: A
authors: Nagler
authors: EBMT-ALWP Office and University Pierre and Marie Curie, Department of Hematology, Hospital Saint Antoine, Paris, France.
authors: M
authors: M
authors: Mohty
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D020544:Graft vs Leukemia Effect; D006239:Haplotypes; D018380:Hematopoietic Stem Cell Transplantation; D006650:Histocompatibility Testing; D006801:Humans; D007223:Infant; D007938:Leukemia / Q000401:mortality / Q000628:therapy*; D008875:Middle Aged; D016016:Proportional Hazards Models; D012008:Recurrence