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Haploidentical vs sibling, unrelated, or cord blood hematopoietic cell transplantation for acute lymphoblastic leukemia.

ABSTRACT: The role of haploidentical hematopoietic cell transplantation (HCT) using posttransplant cyclophosphamide (PTCy) for acute lymphoblastic leukemia (ALL) is being defined. We performed a retrospective, multivariable analysis comparing outcomes of HCT approaches by donor for adults with ALL in remission. The primary objective was to compare overall survival (OS) among haploidentical HCTs using PTCy and HLA-matched sibling donor (MSD), 8/8 HLA-matched unrelated donor (MUD), 7 /8 HLA-MUD, or umbilical cord blood (UCB) HCT. Comparing haploidentical HCT to MSD HCT, we found that OS, leukemia-free survival (LFS), nonrelapse mortality (NRM), relapse, and acute graft-versus-host disease (aGVHD) were not different but chronic GVHD (cGVHD) was higher in MSD HCT. Compared with MUD HCT, OS, LFS, and relapse were not different, but MUD HCT had increased NRM (hazard ratio [HR], 1.42; P = .02), grade 3 to 4 aGVHD (HR, 1.59; P = .005), and cGVHD. Compared with 7/8 UD HCT, LFS and relapse were not different, but 7/8 UD HCT had worse OS (HR, 1.38; P = .01) and increased NRM (HR, 2.13; P ≤ .001), grade 3 to 4 aGVHD (HR, 1.86; P = .003), and cGVHD (HR, 1.72; P ≤ .001). Compared with UCB HCT, late OS, late LFS, relapse, and cGVHD were not different but UCB HCT had worse early OS (≤18 months; HR, 1.93; P < .001), worse early LFS (HR, 1.40; P = .007) and increased incidences of NRM (HR, 2.08; P < .001) and grade 3 to 4 aGVHD (HR, 1.97; P < .001). Haploidentical HCT using PTCy showed no difference in survival but less GVHD compared with traditional MSD and MUD HCT and is the preferred alternative donor HCT option for adults with ALL in complete remission.

SUBMITTER: Wieduwilt MJ

PROVIDER: S-EPMC8753217 | biostudies-literature | 2022 Jan

REPOSITORIES: biostudies-literature

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Haploidentical vs sibling, unrelated, or cord blood hematopoietic cell transplantation for acute lymphoblastic leukemia.

Wieduwilt Matthew J MJ Metheny Leland L Zhang Mei-Jie MJ Wang Hai-Lin HL Estrada-Merly Noel N Marks David I DI Al-Homsi A Samer AS Muffly Lori L Chao Nelson N Rizzieri David D Gale Robert Peter RP Gadalla Shahinaz M SM Cairo Mitchell M Mussetti Alberto A Gore Steven S Bhatt Vijaya Raj VR Patel Sagar S SS Michelis Fotios V FV Inamoto Yoshihiro Y Badawy Sherif M SM Copelan Edward E Palmisiano Neil N Kharfan-Dabaja Mohamed A MA Lazarus Hillard M HM Ganguly Siddhartha S Bredeson Christopher C Diaz Perez Miguel Angel MA Cassaday Ryan R Savani Bipin N BN Ballen Karen K Martino Rodrigo R Wirk Baldeep B Bacher Ulrike U Aljurf Mahmoud M Bashey Asad A Murthy Hemant S HS Yared Jean A JA Aldoss Ibrahim I Farhadfar Nosha N Liu Hongtao H Abdel-Azim Hisham H Waller Edmund K EK Solh Melhem M Seftel Matthew D MD van der Poel Marjolein M Grunwald Michael R MR Liesveld Jane L JL Kamble Rammurti T RT McGuirk Joseph J Munker Reinhold R Cahn Jean-Yves JY Lee Jong Wook JW Freytes César O CO Krem Maxwell M MM Winestone Lena E LE Gergis Usama U Nathan Sunita S Olsson Richard F RF Verdonck Leo F LF Sharma Akshay A Ringdén Olle O Friend Brian D BD Cerny Jan J Choe Hannah H Chhabra Saurabh S Nishihori Taiga T Seo Sachiko S George Biju B Baxter-Lowe Lee Ann LA Hildebrandt Gerhard C GC de Lima Marcos M Litzow Mark M Kebriaei Partow P Hourigan Christopher S CS Abid Muhammad Bilal MB Weisdorf Daniel J DJ Saber Wael W

Blood advances 20220101 1

The role of haploidentical hematopoietic cell transplantation (HCT) using posttransplant cyclophosphamide (PTCy) for acute lymphoblastic leukemia (ALL) is being defined. We performed a retrospective, multivariable analysis comparing outcomes of HCT approaches by donor for adults with ALL in remission. The primary objective was to compare overall survival (OS) among haploidentical HCTs using PTCy and HLA-matched sibling donor (MSD), 8/8 HLA-matched unrelated donor (MUD), 7 /8 HLA-MUD, or umbilica ...[more]

PMID: 34547770

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Project description:Unrelated umbilical cord blood (UCB) and haploidentical grafts have been used for allogeneic hematopoietic stem and progenitor cell (HSPC) transplantation in patients without a related or non-related human leukocyte antigen (HLA)-matched donor. The less stringent HLA-matching requirement in both sources raises an important possibility for patients in need of urgent transplantation to treat any hematological disease. Selection of the best alternative donor is a difficult task that will depend on donor criteria, center experience, patient disease conditions, and risk, among others. Most comparisons available in scientific publications between both graft sources are obtained from retrospective analysis in wide time windows and a heterogeneous number of patients, types of disease, disease stages, previous treatments, graft source, conditioning regimen, graft vs. host disease (GVHD) approach, and evaluable endpoints. There is also an evident impact of the economic traits since low-income countries must consider less expensive treatments to satisfy the needs of the patients in the most effective possible path. Therefore, haploidentical transplantation could be an appealing option, even though it has not been completely established if any chronic treatment derived from the procedure could become a higher cost. In Colombia, there is a huge experience in UCB transplantation especially in units of pediatric transplantation where benign indications are more common than in adults. Due to the availability of a public UCB bank and HLA high-resolution typing in Colombia, there is a wider inventory of cord blood donors. Unfortunately, we do not have an unrelated bone marrow donor registry, so UCB is an important source along with haploidentical transplantation to consider in decision-making. This minireview focuses on comparing the main issues associated with the use of both HSCP sources and provides tools for physicians who face the difficult decision between these alternative donor sources.

Dataset Information

Haploidentical vs sibling, unrelated, or cord blood hematopoietic cell transplantation for acute lymphoblastic leukemia.

Publications

Haploidentical vs sibling, unrelated, or cord blood hematopoietic cell transplantation for acute lymphoblastic leukemia.

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