1
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Montes de Oca C, Castagna L, De Philippis C, Bramanti S, Schiano JM, Pagliardini T, Collignon A, Harbi S, Mariotti J, Granata A, Maisano V, Furst S, Legrand F, Chabannon C, Carlo-Stella C, Santoro A, Blaise D, Devillier R. Nonmyeloablative Conditioning Regimen before T Cell Replete Haploidentical Transplantation with Post-Transplant Cyclophosphamide for Advanced Hodgkin and Non-Hodgkin Lymphomas. Biol Blood Marrow Transplant 2020; 26:2299-2305. [PMID: 32822845 DOI: 10.1016/j.bbmt.2020.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/27/2020] [Accepted: 08/09/2020] [Indexed: 12/20/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-SCT) is a valid option in patients with refractory lymphomas. HLA haploidentical stem cell transplantation (haplo-SCT) expanded the accessibility to allogeneic hematopoietic cell transplantation. The aims of study were to retrospectively assess the toxicity and efficacy of haplo-SCT using nonmyeloablative conditioning in patients with advanced lymphoma. In total, 147 patients with advanced lymphoma at 2 partner institutions were included. Patients received a uniform nonmyeloablative conditioning regimen and graft-versus-host disease (GVHD) prophylaxis. The primary endpoints were progression-free survival (PFS), overall survival (OS), GVHD, nonrelapse mortality, and GVHD, relapse-free survival (GRFS). Median follow-up was 39 months (range, 6 to 114 months). The median age was 46 years (range, 19 to 71 years). Sixty-five percent of patients were in complete remission (CR) at transplantation. Cumulative incidence of grade II to IV acute GVHD was 30% (95% confidence interval [Cl], 23% to 38%). Two-year cumulative incidence of all grades of chronic GVHD was 13% (95% CI, 8% to 20%). Two-year cumulative incidence of disease relapse was 19% (95% CI, 14% to 27%), with a higher incidence in patients not being in CR at allo-HCT (CR versus not CR: 12% versus 33%, P = .006). Two-year PFS, OS, and GRFS were 66% (95% CI, 59-75), 73% (95% CI, 66-81), and 56% (95% CI, 48-65), respectively. Haplo-SCT with post-transplantation cyclophosphamide may be considered a valid option for patients with aggressive lymphoma and deserves further evaluation.
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Affiliation(s)
- Catalina Montes de Oca
- Hematology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | - Luca Castagna
- Humanitas Clinical and Research Center, IRCCS, Milan, Italy.
| | | | | | - Jean Marc Schiano
- Hematology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | - Thomas Pagliardini
- Hematology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | - Aude Collignon
- Hematology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | - Samia Harbi
- Hematology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | | | - Angela Granata
- Hematology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | - Valerio Maisano
- Hematology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | - Sabine Furst
- Hematology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | - Faezeah Legrand
- Hematology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | - Christian Chabannon
- Centre for Clinical Investigation in Biotherapy, Institut Paoli-Calmettes, Aix-Marseille University, Marseille, France
| | - Carmelo Carlo-Stella
- Humanitas Clinical and Research Center, IRCCS, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Armando Santoro
- Humanitas Clinical and Research Center, IRCCS, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Didier Blaise
- Hematology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | - Raynier Devillier
- Hematology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
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2
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Baron F, Ruggeri A, Beohou E, Labopin M, Sanz G, Milpied N, Michallet M, Bacigalupo A, Blaise D, Sierra J, Socié G, Cornelissen JJ, Schmid C, Giebel S, Gorin NC, Esteve J, Ciceri F, Savani BN, Mohty M, Gluckman E, Nagler A. RIC versus MAC UCBT in adults with AML: A report from Eurocord, the ALWP and the CTIWP of the EBMT. Oncotarget 2018; 7:43027-43038. [PMID: 27250025 PMCID: PMC5190005 DOI: 10.18632/oncotarget.9599] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 05/14/2016] [Indexed: 01/08/2023] Open
Abstract
Nonrelapse mortality (NRM) is the first cause of treatment failure after unrelated cord blood transplantation (UCBT) following myeloablative conditioning (MAC). In the last decade, reduced-intensity conditioning (RIC) regimens have been developed with the aim of reducing NRM and allowing older patients and those with medical comorbidities to benefit from UCBT. The aim of the current retrospective study was to compare transplantation outcomes of acute myeloid leukemia (AML) patients given UCBT after either RIC or MAC. Data from 894 adults with AML receiving a single or double UCBT as first allograft from 2004 to 2013 at EBMT centers were included in this study. 415 patients were given UCBT after RIC while 479 patients following a MAC. In comparison to MAC recipients, RIC recipients had a similar incidence of neutrophil engraftment and of acute and chronic graft-versus-host disease (GVHD). However, RIC recipients had a higher incidence of disease relapse and a lower NRM, translating to comparable leukemia-free (LFS), GVHD-free, relapse-free survival (GRFS) and overall survival (OS). These observations remained qualitatively similar after adjusting for differences between groups in multivariate analyses. In conclusion, these data suggest that LFS and OS are similar with RIC or with MAC in adults AML patients transplanted with UCBT. These observations could serve as basis for a future prospective randomized study.
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Affiliation(s)
| | - Annalisa Ruggeri
- Eurocord, Hospital Saint Louis, AP-HP, and IUH University Paris VII, Paris, France.,AP-HP, Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France
| | - Eric Beohou
- EBMT Paris Office, Hospital Saint Antoine, Paris, France
| | - Myriam Labopin
- EBMT Paris Office, Hospital Saint Antoine, Paris, France
| | - Guillermo Sanz
- Hospital Universitario La Fe, Servicio de Hematologia, Valencia, Spain
| | - Noel Milpied
- CHU Bordeaux, Hématologie Clinique et Thérapie Cellulaire-Hôpital Haut-leveque, Bordeaux, France.,University of Bordeaux, Bordeaux, France
| | | | | | - Didier Blaise
- Institut Paoli Calmettes (IPC), Aix Marseille University (AMU), UM105, Centre de Recherche en Cancerologie (CRCM), Inserm U1068, CNRS UMR7258 Marseille, Marseille, France
| | - Jorge Sierra
- Hospital Santa Creu i Sant Pau, Hematology Department, Barcelona, Spain
| | - Gérard Socié
- AP-HP, Hematology Transplantation, Hospital Saint-Louis, Paris, France
| | - Jan J Cornelissen
- Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
| | - Christoph Schmid
- Klinikum Augsburg, Department of Hematology and Oncology, University of Munich, Augsburg, Germany
| | - Sebastian Giebel
- Maria Sklodowska-Curie Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Norbert-Claude Gorin
- AP-HP, Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France.,EBMT Paris Office, Hospital Saint Antoine, Paris, France
| | - Jordi Esteve
- Deptartment of Hematology, Hospital Clinic, Barcelona, Spain
| | - Fabio Ciceri
- Department of Hematology, Ospedale San Raffaele, Università degli Studi, Milano, Italy
| | - Bipin N Savani
- Long Term Transplant Clinic, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mohamad Mohty
- AP-HP, Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France.,Universite Pierre & Marie Curie, Paris, France.,INSERM, UMRS 938, Paris, France
| | - Eliane Gluckman
- Eurocord, Hospital Saint Louis, AP-HP, and IUH University Paris VII, France Monacord, Centre Scientifique de Monaco, Monaco
| | - Arnon Nagler
- EBMT Paris Office, Hospital Saint Antoine, Paris, France.,Division of Hematology and Bone Marrow Transplantation, The Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
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3
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Baron F, Ruggeri A, Beohou E, Labopin M, Mohty M, Blaise D, Cornelissen JJ, Chevallier P, Sanz G, Petersen E, Savani BN, Gluckman E, Nagler A. Single- or double-unit UCBT following RIC in adults with AL: a report from Eurocord, the ALWP and the CTIWP of the EBMT. J Hematol Oncol 2017. [PMID: 28637512 PMCID: PMC5479038 DOI: 10.1186/s13045-017-0497-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background The feasibility of cord blood transplantation (CBT) in adults is limited by the relatively low number of hematopoietic stem/progenitor cells contained in one single CB unit. The infusion of two CB units from different partially HLA-matched donors (double CBT) is frequently performed in patients who lack a sufficiently rich single CB unit. Methods We compared CBT outcomes in patients given single or double CBT following reduced-intensity conditioning (RIC) in a retrospective multicenter registry-based study. Inclusion criteria included adult (≥18 years) patients, acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL), complete remission (CR) at the time of transplantation, first single (with a cryopreserved TNC ≥ 2.5 × 107/kg) or double CBT between 2004 and 2014, and RIC conditioning. Results Data from 534 patients with AML (n = 408) or ALL (n = 126) receiving a first single (n = 172) or double (n = 362) CBT were included in the analyses. In univariate analysis, in comparison to patients transplanted with a single CB, double CB recipients had a similar incidence of neutrophil engraftment but a suggestion for a higher incidence of grade II–IV acute GVHD (36 versus 28%, P = 0.08). In multivariate analyses, in comparison to single CBT recipients, double CBT patients had a comparable incidence of relapse (HR = 0.9, P = 0.5) and of nonrelapse mortality (HR = 0.8, P = 0.3), as well as comparable overall (HR = 0.8, P = 0.17), leukemia-free (HR = 0.8, P = 0.2) and GVHD-free, relapse-free (HR = 1.0, P = 0.3) survival. Conclusions These data failed to demonstrate better transplantation outcomes in adult patients receiving double CBT in comparison to those receiving single CBT with adequate TNC after RIC. Electronic supplementary material The online version of this article (doi:10.1186/s13045-017-0497-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Frédéric Baron
- Department of Hematology, University of Liege, CHU Sart-Tilman, 4000, Liege, Belgium.
| | - Annalisa Ruggeri
- Eurocord, Hospital Saint Louis, AP-HP, and IUH University Paris VII, Paris, France.,AP-HP, Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France
| | - Eric Beohou
- EBMT Paris Office, Hospital Saint Antoine, Paris, France
| | - Myriam Labopin
- EBMT Paris Office, Hospital Saint Antoine, Paris, France
| | - Mohamad Mohty
- AP-HP, Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France
| | - Didier Blaise
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
| | - Jan J Cornelissen
- Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
| | | | - Guillermo Sanz
- Servicio de Hematologia, Hospital Universitario La Fe, Valencia, Spain
| | - Eefke Petersen
- Department of Hematology, University Medical Centre, Utrecht, The Netherlands
| | - Bipin N Savani
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eliane Gluckman
- Eurocord, Hospital Saint Louis, AP-HP, and IUH University Paris VII, France Monacord, Centre Scientifique de Monaco, Monaco, Monaco
| | - Arnon Nagler
- EBMT Paris Office, Hospital Saint Antoine, Paris, France.,Division of Hematology and Bone Marrow Transplantation, The Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel and the EBMT Paris Office, Hospital Saint Antoine, Paris, France
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4
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Conditioning regimens for allogeneic hematopoietic stem cell transplants in acute myeloid leukemia. Bone Marrow Transplant 2017; 52:1504-1511. [DOI: 10.1038/bmt.2017.83] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 02/06/2017] [Accepted: 02/24/2017] [Indexed: 12/24/2022]
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5
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Clinical separation of cGvHD and GvL and better GvHD-free/relapse-free survival (GRFS) after unrelated cord blood transplantation for AML. Bone Marrow Transplant 2016; 52:88-94. [DOI: 10.1038/bmt.2016.182] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 05/14/2016] [Accepted: 05/20/2016] [Indexed: 11/08/2022]
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Lucchini G, Perales MA, Veys P. Immune reconstitution after cord blood transplantation: peculiarities, clinical implications and management strategies. Cytotherapy 2016; 17:711-722. [PMID: 25946726 DOI: 10.1016/j.jcyt.2015.03.614] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 03/12/2015] [Indexed: 12/26/2022]
Abstract
Umbilical cord blood (UCB) is now widely used as an alternative hematopoietic stem cell source for patients lacking closely matched related or unrelated adult donors. UCB transplantation has traditionally been associated with delayed engraftment, poor immune reconstitution and consequent increased risk of infection. More recent clinical studies, however, suggest that conditioning regimens and in particular the omission of in vivo T-cell depletion may play a crucial role in post-transplant T-cell expansion, facilitating a uniquely rapid immune recovery after UCB transplantation. The peculiar characteristics of UCB cells, the importance of thymic function and the role of conditioning regimens and graft-versus-host disease influencing immune reconstitution are described. The last part of the review reports available data on UCB, as well as third-party peripheral blood derived anti-viral cell therapy, which provides a novel approach to rescue UCB recipients with viral complications in the post-transplant period.
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Affiliation(s)
- Giovanna Lucchini
- Bone Marrow Transplantation Department, Great Ormond Street Hospital, London, United Kingdom.
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, USA
| | - Paul Veys
- Bone Marrow Transplantation Department, Great Ormond Street Hospital, London, United Kingdom
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7
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Sengsayadeth S, Savani BN, Blaise D, Malard F, Nagler A, Mohty M. Reduced intensity conditioning allogeneic hematopoietic cell transplantation for adult acute myeloid leukemia in complete remission - a review from the Acute Leukemia Working Party of the EBMT. Haematologica 2016; 100:859-69. [PMID: 26130513 DOI: 10.3324/haematol.2015.123331] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Acute myeloid leukemia is the most common indication for an allogeneic hematopoietic cell transplant. The introduction of reduced intensity conditioning has expanded the recipient pool for transplantation, which has importantly made transplant an option for the more commonly affected older age groups. Reduced intensity conditioning allogeneic transplantation is currently the standard of care for patients with intermediate or high-risk acute myeloid leukemia and is now most often employed in older patients and those with medical comorbidities. Despite being curative for a significant proportion of patients, post-transplant relapse remains a challenge in the reduced intensity conditioning setting. Herein we discuss the studies that demonstrate the feasibility of reduced intensity conditioning allogeneic transplants, compare the outcomes of reduced intensity conditioning versus chemotherapy and conventional myeloablative conditioning regimens, describe the optimal donor and stem cell source, and consider the impact of post-remission consolidation, comorbidities, center experience, and more intensive (reduced toxicity conditioning) regimens on outcomes. Additionally, we discuss the need for further prospective studies to optimize transplant outcomes.
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Affiliation(s)
- Salyka Sengsayadeth
- Section of Hematology and Stem Cell Transplant, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bipin N Savani
- Section of Hematology and Stem Cell Transplant, Vanderbilt University Medical Center, Nashville, TN, USA Acute Leukemia Working Party of the EBMT, Marseille, France
| | - Didier Blaise
- Programme de Transplantation & Therapie Cellulaire - Centre de Recherche en Cancérologie de Marseille - Institut Paoli Calmettes, Marseille, France
| | - Florent Malard
- Department of Haematology, Saint Antoine Hospital, Paris, France INSERM UMR 938, Paris, France Université Pierre et Marie Curie, Paris, France
| | - Arnon Nagler
- Acute Leukemia Working Party of the EBMT, Marseille, France Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel EBMT Paris Study Office/CEREST-TC, Paris, France
| | - Mohamad Mohty
- Department of Haematology, Saint Antoine Hospital, Paris, France INSERM UMR 938, Paris, France Université Pierre et Marie Curie, Paris, France EBMT Paris Study Office/CEREST-TC, Paris, France
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8
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Alam N, Atenafu EG, Kuruvilla J, Uhm J, Lipton JH, Messner HA, Kim DH, Seftel M, Gupta V. Outcomes of patients with therapy-related AML/myelodysplastic syndrome (t-AML/MDS) following hematopoietic cell transplantation. Bone Marrow Transplant 2015; 50:1180-6. [PMID: 26121109 DOI: 10.1038/bmt.2015.151] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 04/14/2015] [Accepted: 05/13/2015] [Indexed: 11/09/2022]
Abstract
We studied outcomes of 65 consecutive patients with therapy-related AML/myelodyplastic syndrome (t-AML/MDS) who underwent allogeneic hematopoietic cell transplantation (HCT). Previously published scores of HCT-CI, CIBMTR, EBMT and Comorbidity-age index were also evaluated. Median follow-up of survivors was 72 months (range 16-204). At 2 years, overall survival (OS) was 34% (95% confidence interval (CI) 23-45). Nineteen patients (29%) had monosomal karyotype (MK). Patients with MK had an OS of 21% (95% CI 7-41) at 2 years. Abnormal adverse cytogenetics, unrelated donor, bone marrow graft and CIBMTR score were significant risk factors for OS on univariate analysis. On multivariate analysis, abnormal adverse cytogenetics (hazard ratio (HR) 2.7; 95% CI 1.02-7.2; P-value=0.02) and unrelated donor (HR 2.7; 95% CI 1.5-5.0; P-value=0.0013) were independent factors for survival. Non-relapse mortality (NRM) at 2 years was 31% (95% CI 15-47). Donor type was the only factor that was significant for NRM with matched related donors having an NRM of 20% (95% CI 0-42) whereas unrelated donors had NRM of 60% (95% CI 40-80; P-value=0.0007). In conclusion, patients with t-AML/MDS have poor OS. Unrelated donor is a significant risk factor for both higher NRM and decreased OS. Cytogenetics are predictive for OS.
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Affiliation(s)
- N Alam
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - E G Atenafu
- Department of Biostatistics, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - J Kuruvilla
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - J Uhm
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - J H Lipton
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - H A Messner
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - D H Kim
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - M Seftel
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - V Gupta
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
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9
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Kanakry CG, de Lima MJ, Luznik L. Alternative Donor Allogeneic Hematopoietic Cell Transplantation for Acute Myeloid Leukemia. Semin Hematol 2015; 52:232-42. [PMID: 26111471 DOI: 10.1053/j.seminhematol.2015.03.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Allogeneic hematopoietic cell transplantation (alloHCT) provides a potentially curative therapy for patients with high-risk or chemorefractory acute myeloid leukemia (AML). Historically, the applicability of alloHCT has been limited as only 30%-35% of patients have human leukocyte antigen (HLA)-matched siblings and outcomes using other donor types have been markedly inferior due to excess toxicity, graft failure, graft-versus-host disease (GVHD), and consequently non-relapse mortality. Advances in HLA typing, GVHD prophylactic approaches, and other transplantation techniques have successfully addressed these historical challenges. Herein, we review recent alloHCT studies using volunteer unrelated donors, umbilical cord blood units, or HLA-haploidentical donors, specifically focusing on studies that compared outcomes between donor sources. Although none are randomized and most are retrospective, these analyses suggest that current outcomes for AML patients using most alternative donor types are comparable to those seen using HLA-matched siblings.
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Affiliation(s)
- Christopher G Kanakry
- Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD.
| | - Marcos J de Lima
- University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Leo Luznik
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
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