1. Comparing transplant outcomes in ALL patients after myeloablative conditioning in mismatch-related or unrelated donor settings
- Author
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Otoukesh, Salman, Yang, Dongyun, Mokhtari, Sally, Pourhassan, Hoda, Agrawal, Vaibhav, Arslan, Shukaib, Amanam, Idoroenyi, Ball, Brian, Koller, Paul, Salhotra, Amandeep, Sandhu, Karamjeet, Aribi, Ahmed, Artz, Andrew, Aldoss, Ibrahim, Pullarkat, Vinod, Ali, Haris, Blackmon, Amanda, Becker, Pamela, Curtin, Peter, Stewart, Forrest, Smith, Eileen, Stein, Anthony, Marcucci, Guido, Forman, Stephen J., Nakamura, Ryotaro, and Al Malki, Monzr M.
- Abstract
The optimal myeloablative conditioning regimen for ALL patients undergoing hematopoietic cell transplant (HCT) with an alternative donor is unknown. We analyzed HCT outcomes ALL patients (n= 269) who underwent HCT at our center from 2010 to 2020 in complete remission (CR) after FTBI-etoposide and CNI-based GvHD prophylaxis for matched donor HCT (ETOP-package; n= 196) or FTBI-Fludarabine and post-transplant cyclophosphamide (PTCy)-based prophylaxis for HLA- mismatched (related or unrelated) donors (FLU-package; n= 64). Patients in FLU-package showed a significant delay in engraftment (p< 0.001) and lower cumulative incidence (CI) of any and extensive chronic GVHD (p= 0.009 and 0.001, respectively). At the median follow up of 4.6 years (range 1–12 years); non-relapse mortality, overall or leukemia-free survival and GVHD-free/relapse-free survival were not significantly impacted by the choice of conditioning. However, in patients at CR2 or with measurable residual disease (MRD+), there was a trend towards higher relapse after FLU-package (p= 0.08 and p= 0.07, respectively), while patients at CR1 regardless of MRD status had similar outcomes despite the package/donor type (p= 0.9 and 0.7, respectively). Our data suggests that FLU-package for alternative donors offers comparable outcomes to ETOP-package for matched donor HCT to treat ALL. Disease status and depth of remission at HCT were independent predictors for better outcomes.
- Published
- 2024
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