1. Haploidentical transplant with posttransplant cyclophosphamide vs matched unrelated donor transplant for acute myeloid leukemia.
- Author
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Ciurea, Stefan O., Mei-Jie Zhang, Bacigalupo, Andrea A., Bashey, Asad, Appelbaum, Frederick R., Aljitawi, Omar S., Armand, Philippe, Antin, Joseph H., Junfang Chen, Devine, Steven M., Fowler, Daniel H., Luznik, Leo, Nakamura, Ryotaro, O'Donnell, Paul V., Perales, Miguel-Angel, Pingali, Sai Ravi, Porter, David L., Riches, Marcie R., Ringdén, Olle T. H., and Rocha, Vanderson
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MYELOID leukemia , *HEMATOPOIETIC stem cell transplantation , *CALCINEURIN , *MYCOPHENOLIC acid , *CYCLOPHOSPHAMIDE , *GRAFT versus host disease - Abstract
We studied adults with acute myeloid leukemia (AML) after haploidentical (n=192) and 8/8 HLA-matched unrelated donor (n=1982), transplantation. Data were obtained from the Center for International Blood and Marrow Transplant Research. Haploidentical recipients received calcineurin inhibitor (CNI), mycophenolate and post-transplant cyclophosphamide for graft-versus-host disease (GVHD) prophylaxis; 104 patients received myeloablative and 88, reduced intensity conditioning regimens. Matched unrelated donor transplant recipients received CNI with mycophenolate or methotrexate for GVHD prophylaxis; 1245 patients received myeloablative and 737, reduced intensity conditioning regimens. In the myeloablative setting, day-30 neutrophil recovery was lower after haploidentical compared to matched unrelated donor transplants (90% versus 97%, p=0.02). Corresponding rates after reduced intensity conditioning transplants were 93% and 96%, (p=0.25). In the myeloablative setting, 3-month acute grade 2-4 (16% versus 33%, p<0.0001) and 3-year chronic GVHD (30% versus 53%, p<0.0001) were lower after haploidentical compared to matched unrelated donor transplants. Similar differences were observed after reduced intensity conditioning transplants, 19% versus 28%, (p=0.05) and 34% versus 52%, (p=0.002). Among patients receiving myeloablative regimens, 3-year probabilities of overall survival were 45% (95% CI 36-54) and 50% (95% CI 47-53) after haploidentical and matched unrelated donor transplants (p=0.38). Corresponding rates after reduced intensity conditioning transplants were 46% (95% CI 35-56) and 44% (95% CI 0.40-47) (p=0.71). Although statistical power is limited, these data suggests that survival for patients with AML after haploidentical transplantation with posttransplant cyclophosphamide is comparable with matched unrelated donor transplantation. [ABSTRACT FROM AUTHOR]
- Published
- 2015
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