title: T Cell-Replete Peripheral Blood Haploidentical Hematopoietic Cell Transplantation with Post-Transplantation Cyclophosphamide Results in Outcomes Similar to Transplantation from Traditionally Matched Donors in Active Disease Acute Myeloid Leukemia.
abstract: Outcomes for patients with acute myeloid leukemia (AML) who fail to achieve complete remission remain poor. Hematopoietic cell transplantation (HCT) has been shown to induce long-term survival in AML patients with active disease. HCT is largely performed with HLA-matched unrelated or HLA-matched related donors. Recently, HCT with HLA-haploidentical related donors has been identified as a feasible option when HLA-matched donors are not immediately available. However, there are little data comparing outcomes for AML patients with active disease who receive haploidentical versus traditionally matched HCT. We retrospectively analyzed data from 99 AML patients with active disease undergoing allogeneic HCT at a single institution. Forty-three patients received unrelated donor HCT, 32 patients received matched related donor HCT, and 24 patients received peripheral blood haploidentical HCT with post-transplantation cyclophosphamide. We found no significant differences between treatment groups in terms of overall survival (OS), event-free survival, transplantation-related mortality, cumulative incidence of relapse, and cumulative incidence of acute and chronic graft-versus-host disease (GVHD). We performed univariate regression analysis of variables that modified OS in all patients and found only younger age at transplantation and development of chronic GVHD significantly improved outcome. Although limited by our relatively small sample size, these results indicate that haploidentical HCT in active AML patients have comparable outcomes to HCT with traditionally matched donors. Haploidentical HCT can be considered in this population of high-risk patients when matched donors are unavailable or when wait times for transplantation are unacceptably long.
authors.affiliation: BMT and Leukemia Program, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Joan
authors.initials: J
authors.lastname: How
authors.affiliation: BMT and Leukemia Program, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Michael
authors.initials: M
authors.lastname: Slade
authors.affiliation: BMT and Leukemia Program, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Khoan
authors.initials: K
authors.lastname: Vu
authors.affiliation: BMT and Leukemia Program, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: John F
authors.initials: JF
authors.lastname: DiPersio
authors.affiliation: BMT and Leukemia Program, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Peter
authors.initials: P
authors.lastname: Westervelt
authors.affiliation: BMT and Leukemia Program, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Geoffrey L
authors.initials: GL
authors.lastname: Uy
authors.affiliation: BMT and Leukemia Program, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Camille N
authors.initials: CN
authors.lastname: Abboud
authors.affiliation: BMT and Leukemia Program, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Ravi
authors.initials: R
authors.lastname: Vij
authors.affiliation: BMT and Leukemia Program, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schroeder
authors.affiliation: BMT and Leukemia Program, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Todd A
authors.initials: TA
authors.lastname: Fehniger
authors.affiliation: BMT and Leukemia Program, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri. Electronic address: rromee@wustl.edu.
authors.forename: Rizwan
authors.initials: R
authors.lastname: Romee
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D006086:Graft vs Host Disease; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods / Q000401:mortality* / Q000592:standards; D006648:Histocompatibility; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013601:T-Lymphocytes / Q000166:cytology*; D014019:Tissue Donors / Q000600:supply & distribution*; D000075442:Transplantation, Haploidentical / Q000379:methods / Q000401:mortality* / Q000592:standards; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003520:Cyclophosphamide
keywords: Active disease; Acute myeloid leukemia; Haploidentical transplantation