Publicaciones científicas
Post-transplant cyclophosphamide after HLA identical compared to Haploidentical donor transplant in Acute Myeloid Leukemia: a study on behalf of GETH-TC
Rebeca Bailén 1 , María Jesús Pascual-Cascón 2 , Manuel Guerreiro 3 , Lucía López-Corral 4 , Anabelle Chinea 5 , Arancha Bermúdez 6 , Antonia Sampol 7 , Inmaculada Heras 8 , Estefanía García-Torres 9 , Melissa Torres 10 , José Rifón Roca 11 , Beatriz Herruzo 2 , Jaime Sanz 3 , Marta Fonseca 4 , Pilar Herrera 5 , Mercedes Colorado 6 , Leyre Bento 7 , Oriana López-Godino 8 , Carmen Martín-Calvo 9 , Paula Fernández-Caldas 10 , María Marcos-Jubilar 11 , Isabel Sánchez-Ortega 12 , Carlos Solano 13 , Víctor Noriega 14 , Karem Humala 15 , Gillen Oarbeascoa 1 , J L José Luis Díez-Martín 16 , Mi Kwon 17 , Grupo Español de Trasplante Hematopoyético y Terapia Celular (GETH)
Background: Post-transplant cyclophosphamide (PTCY) effectively prevents graft-versus-host disease (GVHD) after unmanipulated HLA-haploidentical hematopoietic stem cell transplantation (HSCT) and achieves low rates of GVHD in HLA identical transplantation.
Objective: To compare the outcomes of haploidentical versus HLA identical HSCT in patients undergoing HSCT for acute myeloid leukemia (AML) using PTCY.
Study design: We conducted a retrospective study of 229 patients undergoing first HSCT for AML using PTCY with additional immunosuppression, 99 from matched sibling or unrelated donor (MSD/MUD) performed in 3 hospitals and 130 from haploidentical donors (haplo group) performed in 20 hospitals within the Spanish Group of Hematopoietic Stem Cell Transplantation and Cellular Therapy (GETH-TC).
Results: Peripheral blood stem cells were used as graft in 89% of patients; myeloablative conditioning was used in 56%. There were significantly more patients with active disease (5% vs. 20%, p = 0.001), high/very high DRI (32% vs. 67%, p = 0.000) and prior auto-HSCT (2% vs. 11%, p = 0.010) in the haplo group. Median follow-up was 27 and 62.5 months for MSD/MUD and haplo, respectively. At 2 years, no significant differences were observed in overall survival (OS) (72% vs. 62%, p = 0.07), event-free survival (EFS) (70% vs. 54%, p = 0.055), cumulative incidence of relapse (19% vs. 25%, p = 0.13), non-relapse mortality (14% vs. 19%, p = 0.145) and the composite endpoint of GVHD and relapse-free survival (GRFS) (49% vs. 42%, p = 0.249).
Multivariate analysis identified only age and active disease as significant risk factors for OS and EFS; reduced intensity conditioning, high/very high DRI and haplo donor were nearly statistically significant for these outcomes. Grade II-IV acute GVHD was lower in MSD/MUD (14% vs. 47%, p = 0.000). Cumulative incidences of grade III-IV acute GVHD (4% vs. 9%, p = 0.14) and moderate-severe chronic GVHD (22% vs. 19%, p = 0.28) were similar. Limitations of our study include limited sample size, differences between haplo and MSD/MUD groups and heterogeneous additional immunosuppression and PTCY timing in MSD/MUD.
Conclusions: The use of a HLA identical donor with PTCY in patients with AML showed lower incidence of clinically significant grade II-IV acute GVHD compared to haplo donors. Further studies with larger sample size should be performed to establish a possible benefit of HLA identical donor on survival.
CITA DEL ARTÍCULO Transplant Cell Ther. 2022 Jan 30;S2666-6367(22)00048-3. doi: 10.1016/j.jtct.2022.01.020
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