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Outcomes of haploidentical vs matched sibling transplantation for acute myeloid leukemia in first complete remission
Univ Minnesota, Dept Hematol Oncol & Transplantat, Minneapolis, MN USA.ORCID iD: 0000-0002-9384-272X
Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA.ORCID iD: 0000-0001-5372-510X
Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA;Med Coll Wisconsin, Div Biostat, Inst Hlth & Soc, Milwaukee, WI 53226 USA.
Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA.
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2019 (English)In: BLOOD ADVANCES, ISSN 2473-9529, Vol. 3, no 12, p. 1826-1836Article in journal (Refereed) Published
Abstract [en]

HLA-haploidentical hematopoietic cell transplantation (Haplo-HCT) using posttransplantation cyclophosphamide (PT-Cy) has improved donor availability. However, a matched sibling donor (MSD) is still considered the optimal donor. Using the Center for International Blood and Marrow Transplant Research database, we compared outcomes after Haplo-HCT vs MSD in patients with acute myeloid leukemia (AML) in first complete remission (CR1). Data from 1205 adult CR1 AML patients (2008-2015) were analyzed. A total of 336 patients underwent PT-Cy-based Haplo-HCT and 869 underwent MSD using calcineurin inhibitor-based graft-versus-host disease (GVHD) prophylaxis. The Haplo-HCT group included more reduced-intensity conditioning (65% vs 30%) and bone marrow grafts (62% vs 7%), consistent with current practice. In multivariable analysis, Haplo-HCT and MSD groups were not different with regard to overall survival (P = .15), leukemia-free survival (P = .50), nonrelapse mortality (P = .16), relapse (P = .90), or grade II-IV acute GVHD (P = .98). However, the Haplo-HCT group had a significantly lower rate of chronic GVHD (hazard ratio, 0.38; 95% confidence interval, 0.30-0.48; P < .001). Results of subgroup analyses by conditioning intensity and graft source suggested that the reduced incidence of chronic GVHD in Haplo-HCT is not limited to a specific graft source or conditioning intensity. Center effect and minimal residual disease-donor type interaction were not predictors of outcome. Our results indicate a lower rate of chronic GVHD after PT-Cy-based Haplo-HCT vs MSD using calcineurin inhibitor-based GVHD prophylaxis, but similar other outcomes, in patients with AML in CR1. Haplo-HCT is a viable alternative to MSD in these patients.

Place, publisher, year, edition, pages
AMER SOC HEMATOLOGY , 2019. Vol. 3, no 12, p. 1826-1836
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Hematology
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URN: urn:nbn:se:uu:diva-390823DOI: 10.1182/bloodadvances.2019000050ISI: 000472782500006PubMedID: 31201170OAI: oai:DiVA.org:uu-390823DiVA, id: diva2:1343117
Available from: 2019-08-15 Created: 2019-08-15 Last updated: 2019-08-15Bibliographically approved

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Olsson, Richard F.

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Rashidi, ArminHamadani, MehdiAssal, AmerMurthy, Hemant S.Olsson, Richard F.
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Centrum för klinisk forskning i Sörmland (CKFD)
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