1. Haploidentical transplantation is associated with better overall survival when compared to single cord blood transplantation: an EBMT-Eurocord study of acute leukemia patients conditioned with thiotepa, busulfan, and fludarabine.
- Author
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Giannotti F, Labopin M, Shouval R, Sanz J, Arcese W, Angelucci E, Sierra J, Santasusana JR, Santarone S, Benedetto B, Rambaldi A, Saccardi R, Blaise D, Carella MA, Rocha V, Baron F, Mohty M, Ruggeri A, and Nagler A
- Subjects
- Adult, Aged, Busulfan pharmacology, Cord Blood Stem Cell Transplantation mortality, Female, Humans, Leukemia, Myeloid, Acute pathology, Male, Middle Aged, Retrospective Studies, Survival Rate, Thiotepa pharmacology, Transplantation Conditioning mortality, Transplantation, Haploidentical mortality, Vidarabine pharmacology, Vidarabine therapeutic use, Young Adult, Busulfan therapeutic use, Cord Blood Stem Cell Transplantation methods, Leukemia, Myeloid, Acute therapy, Thiotepa therapeutic use, Transplantation Conditioning methods, Transplantation, Haploidentical methods, Vidarabine analogs & derivatives
- Abstract
Background: Thiotepa-busulfan-fludarabine (TBF) is a widely used conditioning regimen in single umbilical cord blood transplantation (SUCBT). More recently, it was introduced in the setting of non-T cell depleted haploidentical stem cell transplantation (NTD-Haplo). Whether TBF based conditioning provides additional benefit in transplantation from a particular alternative donor type remains to be established., Methods: This was a retrospective study based on an international European registry. We compared outcomes of de-novo acute myeloid leukemia patients in complete remission receiving NTD-Haplo (n = 186) vs. SUCBT (n = 147) following myeloablative conditioning (MAC) with TBF. Median follow-up was 23 months. Treatment groups resembled in baseline characteristics., Results: SUCBT was associated with delayed engraftment and higher graft failure. In multivariate analysis no statistically significant differences were observed between the two groups in terms of acute or chronic graft-versus-host disease (GvHD) (HR = 1.03, p = 0.92 or HR = 1.86, p = 0.21) and relapse incidence (HR = 0.8, p = 0.65). Non-relapse mortality (NRM) was significantly higher in SUCBT as compared to NTD-Haplo (HR = 2.63, p = 0.001); moreover, SUCBT did worse in terms of overall survival (HR = 2.18, p = 0.002), leukemia-free survival (HR = 1.94, p = 0.007), and GvHD relapse-free survival (HR = 2.38, p = 0.0002)., Conclusions: Our results suggest that TBF-MAC might allow for a potent graft-versus-leukemia, regardless of the alternative donor type. Furthermore, in patients receiving TBF-MAC, survival with NTD-Haplo may be better compared to SUCBT due to decreased NRM.
- Published
- 2018
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