title: A comparison between allogeneic stem cell transplantation from unmanipulated haploidentical and unrelated donors in acute leukemia.
abstract: In 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.
  
  
  
  Two 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.
  
  
  
  The 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.
  
  
  
  Patients 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. KEY POINT 1: Better outcomes using fully (10/10) matched unrelated donor for allo-SCT in acute leukemia in remission. KEY POINT 2: Similar outcomes after allo-SCT from unmanipulated haploidentical graft or mismatched (9/10) unrelated donor in acute leukemia in remission.
authors.affiliation: Hematology and Bone Marrow Transplant Unit, San Raffaele Scientific Institute, Milan, Italy.|EBMT ALWP Office, Hospital Saint Antoine, Paris, France.
authors.forename: Simona
authors.identifier: 0000-0002-5908-0792
authors.initials: S
authors.lastname: Piemontese
authors.affiliation: Hematology and Bone Marrow Transplant Unit, San Raffaele Scientific Institute, Milan, Italy.|EBMT ALWP Office, Hospital Saint Antoine, Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Ciceri
authors.affiliation: EBMT ALWP Office, Hospital Saint Antoine, Paris, France.|Clinical Hematology and Cellular Therapy Department, Hospital Saint Antoine, APHP, Universite Pierre et Marie Curie, INSERM UMRs 938, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Labopin
authors.affiliation: Stem Cell Transplant Unit, Fondazione Policlinico Tor Vergata, Tor Vergata University, Rome, Italy.
authors.forename: W
authors.initials: W
authors.lastname: Arcese
authors.affiliation: University Department of Hematology and BMT, Medical University of Silesia, Katowice, Poland.
authors.forename: S
authors.initials: S
authors.lastname: Kyrcz-Krzemien
authors.affiliation: Department of Hematology, Ospedale Civile, Pescara, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Santarone
authors.affiliation: Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China.
authors.forename: H
authors.initials: H
authors.lastname: Huang
authors.affiliation: Department of Bone Marrow Transplantation, University Hospital, Essen, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Beelen
authors.affiliation: EBMT ALWP Office, Hospital Saint Antoine, Paris, France.|Clinical Hematology and Cellular Therapy Department, Hospital Saint Antoine, APHP, Universite Pierre et Marie Curie, INSERM UMRs 938, Paris, France.
authors.forename: N C
authors.initials: NC
authors.lastname: Gorin
authors.affiliation: Center for Clinical Hematology, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: C
authors.initials: C
authors.lastname: Craddock
authors.affiliation: Bone Marrow Transplantation Department, Anadolu Medical Center Hospital, Gebze, Turkey.
authors.forename: Z
authors.initials: Z
authors.lastname: Gulbas
authors.affiliation: Division of Hematology II, IRCCS, San Martino University Hospital IST, Genoa, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Bacigalupo
authors.affiliation: EBMT ALWP Office, Hospital Saint Antoine, Paris, France.|Clinical Hematology and Cellular Therapy Department, Hospital Saint Antoine, APHP, Universite Pierre et Marie Curie, INSERM UMRs 938, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Mohty
authors.affiliation: EBMT ALWP Office, Hospital Saint Antoine, Paris, France.|Division of Hematology, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Nagler
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D064591:Allografts; D016026:Bone Marrow Transplantation; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology / Q000209:etiology; D006680:HLA Antigens / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D053208:Kaplan-Meier Estimate; D007938:Leukemia / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D019172:Transplantation Conditioning / Q000379:methods; D016896:Treatment Outcome; D061349:Unrelated Donors; D055815:Young Adult
chemical_list: D006680:HLA Antigens