1
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Bug G, Labopin M, Kulagin A, Blaise D, Raiola AM, Vydra J, Sica S, Kwon M, López-Corral L, Bramanti S, von dem Borne P, Itälä-Remes M, Martino M, Koc Y, Brissot E, Giebel S, Nagler A, Ciceri F, Mohty M. Tacrolimus versus cyclosporine a combined with post-transplantation cyclophosphamide for AML In first complete remission: a study from the acute leukemia working party (EBMT). Bone Marrow Transplant 2024:10.1038/s41409-024-02331-1. [PMID: 38961258 DOI: 10.1038/s41409-024-02331-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 06/09/2024] [Accepted: 06/11/2024] [Indexed: 07/05/2024]
Abstract
Choice of calcineurin inhibitor may impact the outcome of patients undergoing T-cell replete hematopoietic cell transplantation (HCT) with post-transplant cyclophosphamide (PT-Cy) and mycophenolate mofetil (MMF) for prophylaxis of graft-versus-host disease (GVHD). We retrospectively analyzed 2427 patients with acute myeloid leukemia (AML) in first remission transplanted from a haploidentical (n = 1844) or unrelated donor (UD, n = 583) using cyclosporine A (CSA, 63%) or tacrolimus (TAC, 37%) and PT-Cy/MMF. In univariate analysis, CSA and TAC groups did not differ in 2-year leukemia-free or overall survival, cumulative incidence (CI) of relapse or non-relapse mortality. CI of severe grade III-IV acute GVHD was lower with TAC (6.6% vs. 9.1%, p = 0.02), without difference in grade II-IV acute GVHD or grade III-IV acute GVHD/severe chronic GVHD, relapse-free survival (GRFS). In multivariate analysis, TAC was associated with a lower risk of severe grade III-IV acute GVHD solely with haploidentical donors (HR 0.64 [95% CI, 0.42-0.98], p = 0.04), but not UD (HR 0.49 [95% CI, 0.2-1.21], p = 0.12). There was no significant difference for chronic GVHD. In conclusion, PT-Cy/MMF-based GVHD prophylaxis resulted in favorable OS and GRFS, irrespective of the CNI added. In haploidentical HCT, TAC seemed to prevent severe acute GVHD more effectively than CSA without impact on other outcome parameters.
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Affiliation(s)
- Gesine Bug
- Goethe University Frankfurt, University Hospital, Dept of Medicine 2, Frankfurt am Main, Germany.
| | - Myriam Labopin
- Sorbonne University, Department of Hematology, Saint Antoine Hospital, INSERM UMR 938, Paris, France
| | - Alexander Kulagin
- RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russian Federation
| | - Didier Blaise
- Transplant and cellular immunotherapy program, Department of hematology, Institut Paoli Calmettes, Management Sport Cancer lab, Luminy, Aix Marseille University, Marseille, France
| | | | - Jan Vydra
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Simona Sica
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Mi Kwon
- Department of Hematology, Hospital General Universitario Gregorio Marañon, Instituto de Investigación Sanitaria Gregorio Marañón, Univesidad Complutense de Madrid, Madrid, Spain
| | - Lucía López-Corral
- Hospital Universitario de Salamanca (Spain), IBSAL, Centro de Investigación del Cáncer-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Stefania Bramanti
- Department of Oncology/Hematology, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | | | | | - Massimo Martino
- Stem Cell Transplantation and Cellular Therapies Unit (CTMO), Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Yener Koc
- Medicana International Hospital, Istanbul, Turkey
| | - Eolia Brissot
- Sorbonne University, Department of Hematology, Saint Antoine Hospital, INSERM UMR 938, Paris, France
| | - Sebastian Giebel
- Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Arnon Nagler
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Fabio Ciceri
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mohamad Mohty
- Sorbonne University, Department of Hematology, Saint Antoine Hospital, INSERM UMR 938, Paris, France
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2
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Devillier R, Galimard JE, Blaise D, Raiola AM, Bramanti S, Grillo G, Pastano R, de Latour RP, Busca A, López-Corral L, Rodríguez AB, Schmid C, Forcade E, Vydra J, Solano C, Bug G, Neubauer A, Charbonnier A, Brissot E, Nagler A, Ciceri F, Mohty M. Peripheral blood stem cell versus bone marrow graft for patients ≥60 years undergoing reduced intensity conditioning haploidentical transplantation for acute myeloid leukemia in complete remission: An analysis of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Am J Hematol 2024; 99:1250-1256. [PMID: 38778766 DOI: 10.1002/ajh.27343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/01/2024] [Accepted: 04/02/2024] [Indexed: 05/25/2024]
Abstract
In the context of T-cell replete haploidentical stem cell transplantation (Haplo-SCT) using post-transplantation cyclophosphamide (PT-Cy), it is still unknown whether peripheral blood (PB) or bone marrow (BM) is the best graft source. While PB is associated with a higher incidence of graft-versus-host disease (GVHD), it may induce a stronger graft-versus-leukemia effect compared to BM, notably in acute myeloid leukemia (AML). From the EBMT registry database, we compared T-cell replete PB (n = 595) versus BM (n = 209) grafts in a large cohort of 804 patients over the age of 60 years who underwent Haplo-SCT with PT-Cy for an AML in first or second complete remission. The risk of acute GVHD was significantly higher in the PB group (Grade II-IV: HR = 1.67, 95% CI [1.10-2.54], p = 0.01; Grade III-IV: HR = 2.29, 95% CI [1.16-4.54], p = 0.02). No significant difference was observed in chronic GVHD or non-relapse mortality. In the PB group, the risk of relapse was significantly lower in the PB group (HR = 0.65, 95% CI [0.45-0.94], p = 0.02) and leukemia-free survival was significantly better (HR = 0.76, 95% CI [0.59-0.99], p = 0.04), with a trend toward better overall survival (HR = 0.78, 95% CI [0.60-1.01], p = 0.06). We conclude that in the specific context of Haplo-SCT with PT-Cy, PB grafts represent a valid option to decrease the risk of relapse and improve outcome of older AML patients who usually do not benefit from conditioning intensification.
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Affiliation(s)
- Raynier Devillier
- Transplantation and Cell Therapy Program, Institut Paoli Calmettes-Marseille, Centre de Recherche en Cancérologie de Marseille, Aix Marseille University, Marseille, France
| | | | - Didier Blaise
- Transplantation and Cell Therapy Program, Institut Paoli Calmettes-Marseille, Centre de Recherche en Cancérologie de Marseille, Aix Marseille University, Marseille, France
| | - Anna Maria Raiola
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Stefania Bramanti
- Transplantation Unit Department of Oncology and Haematology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Giovanni Grillo
- Department of Hematology and Bone Marrow Transplantation, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Rocco Pastano
- Onco-Haematology Division, European Institute of Oncology IRCCS, IEO, Milan, Italy
| | | | - Alessandro Busca
- S.S. Trapianto di Cellule Staminali, A.O.U Citta della Salute e della Scienza di Torino, Torino, Italy
| | | | | | | | | | - Jan Vydra
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Carlos Solano
- Hospital Clínico de Valencia, Servicio de Hematología-Valencia, Valencia, Spain
| | - Gesine Bug
- Goethe-Universitaet, Medizinische Klinik II, Hämatologie, Medizinische Onkologie, Frankfurt-Main, Germany
| | - Andreas Neubauer
- Philipps Universitaet Marburg, University Hospital Giessen and Marburg, Marburg, Germany
| | | | | | - Arnon Nagler
- Hematology Division, Chaim Sheba Medical Center, Tel-Hashomer, Israel
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3
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Maffini E, Labopin M, Kröger N, Finke J, Stelljes M, Schroeder T, Einsele H, Tischer J, Bornhäuser M, Bethge W, Brecht A, Rösler W, Dreger P, Schäfer-Eckart K, Passweg J, Blau IW, Nagler A, Ciceri F, Mohty M. Allogeneic hematopoietic cell transplantation for older patients with AML with active disease. A study from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT). Bone Marrow Transplant 2024; 59:983-990. [PMID: 38555412 DOI: 10.1038/s41409-024-02275-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/02/2024]
Abstract
Older adults with acute myeloid leukemia (AML) refractory to initial or reinduction chemotherapy have a dismal prognosis if they do not undergo hematopoietic stem-cell transplantation (HCT). However, data assessing HCT outcomes from different donors are scarce. We evaluated results from a retrospective analysis on patients aged ≥70 years, with AML not in remission who received an allogeneic HCT from HLA-matched sibling donor (MSD), HLA-10/10 matched unrelated donor (MUD), or T-cell replete haploidentical (Haplo) donor, from 2010 to 2021, reported to the ALWP-EBMT database. A total of 360 patients (median age 72 years, range 70-79) were included in the analysis. Median follow-up for the entire population was 35.5 months. Donors were MSD (n = 58), 10/10 HLA-MUD (n = 228), and Haplo (n = 74). A total of 213 (59.2%) patients were primary induction failures, while 147 (40.8%) were in first or subsequent relapse. Graft source was peripheral blood in 92% of the patients. Patients transplanted from Haplo donors more frequently received marrow grafts (p < 0.01) and presented the combination female donor to male recipient (p < 0.01). The overall 2-year rates of overall survival (OS) and leukemia-free survival (LFS) were: 62.4% (95% CI 47.2-74.3) and 47.6% (95% CI 33.1-60.8) for MSD, 43% (95% CI 35.8-49.9), and 37.5% (95% CI 30.7-44.4) for MUD, and 25.9% (95% CI 15.8-37.2), and 26.5% (95% CI 16.3-37.8) for recipients of Haplo transplants. The 2-year cumulative incidence of relapse (RI) was slightly lower for Haplo recipients at 29.6% (95% CI 19-40.9), for MUD it was 30.2% (95% CI 23.9-36.7), and for MSD 34.9% (95% CI 22-48.2); counterbalanced by a higher incidence of non-relapse mortality (NRM) of 43.9% (95% CI 31.6-55.6) for Haplo recipients, 32.2% (95% CI 26-33.1) for MUD and 17.5% (95% CI 8.4-29.3) for MSD. Graft-versus-host disease (GVHD-free, relapse-free survival (GRFS) was 35.3% (95% CI 22.3-48.5) for MSD, 29.6% (95% CI 23.2-36.2) for MUD, and 19.2% (95% CI 10.7-29.6) for Haplo patients. In the multivariate model, compared to the referent group of MSD recipients, the risk of NRM was higher among patients transplanted from Haplo donors ([hazard ratio] HR 5.1, 95% CI 2.23-11.61, p < 0.001) and MUD (HR 3.21, 95% CI 1.48-0.6.94, p = 0.003). Furthermore, both Haplo and MUD were associated with inferior OS, (HR 3.6, 95% CI 1.98-0.6.56, p < 0.001, and HR 2.3, 95% CI 1.37-0.3.88, p = 0.002, respectively), and LFS (HR 2.24, 95% CI 1.31-0.3.84, p = 0.003, and HR 1.64, 95% CI 1.04-0.2.60, p = 0.034, respectively). Patients transplanted from Haplo donors were also associated with worse GFRS (HR 1.72, 95% CI 1.07-2.77, p:0.025) compared with MSD patients. Older adult AML patients with active disease transplanted from MSD experienced prolonged OS and LFS compared to 10/10 MUD and Haplo due to lower NRM. Prospective clinical trials are warranted.
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Affiliation(s)
- Enrico Maffini
- IRCCS Azienda Ospedaliero-Universitaria di Bologna; Istituto "L. e A. Seràgnoli", Bologna, Italy.
| | | | - Nicolaus Kröger
- University Medical Center Hamburg, Department for Stem Cell Transplantation, Hamburg, Germany
| | - Jürgen Finke
- Department of Medicine -Hematology Oncology, University of Freiburg, Freiburg, Germany
| | - Matthias Stelljes
- Department of Medicine A, Hematology, Oncology, and Pneumology, University Hospital Münster, Münster, Germany
| | - Thomas Schroeder
- University Hospital, Department of Bone Marrow Transplantation, Essen, Germany
| | - Herman Einsele
- Universitaetsklinikum Wuerzburg, Med. Klinik und Poliklinik II, Wuerzburg, Germany
| | - Johanna Tischer
- Klinikum Grosshadern, Medizinische Klinik III, Munich, Germany
| | - Martin Bornhäuser
- Universitaetsklinikum Dresden, Medizinische Klinik und Poliklinik I, Dresden, Germany
| | - Wolfgang Bethge
- Universitaet Tuebingen Medizinische Klinik, Tuebingen, Germany
| | - Arne Brecht
- Deutsche Klinik fuer Diagnostik, KMT Zentrum, Wiesbaden, Germany
| | - Wolf Rösler
- University Hospital Erlangen, Department of Internal Medicine 5, Erlangen, Germany
| | - Peter Dreger
- University of Heidelberg, Medizinische Klinik u. Poliklinik V, Heidelberg, Germany
| | | | | | - Igor Wolfgang Blau
- Medizinische Klinik m. S. Hämatologie, Onkologie und Tumorimmunologie, Charité Universitätsmedizin, Berlin, Germany
| | - Arnon Nagler
- Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, Ramat-Gan, Israel
| | - Fabio Ciceri
- Ospedale San Raffaele s.r.l., Haematology and BMT, Milano, Italy
| | - Mohamad Mohty
- Sorbonne University, Clinical Hematology and Cellular Therapy Department, Saint Antoine Hospital, INSERM UMRs 938, Paris, France
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4
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Nagler A, Labopin M, Swoboda R, Schroeder T, Hamladji RM, Griskevicius L, Salmenniemi U, Rambaldi A, Mielke S, Kulagin A, Passweg J, Luft T, Gedde-Dahl T, Forcade E, Helbig G, Stelljes M, Castilla-Llorente C, Spyridonidis A, Brissot E, Ciceri F, Mohty M. Post-transplant cyclophosphamide, calcineurin inhibitor, and mycophenolate mofetil compared to anti-thymocyte globulin, calcineurin inhibitor, and methotrexate combinations as graft-versus-host disease prophylaxis post allogeneic stem cell transplantation from sibling and unrelated donors in patients with acute myeloid leukemia: a study on behalf of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Bone Marrow Transplant 2024; 59:1012-1021. [PMID: 38615143 DOI: 10.1038/s41409-024-02284-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/07/2024] [Accepted: 04/08/2024] [Indexed: 04/15/2024]
Abstract
Post-transplant cyclophosphamide plus calcineurin inhibitor (CNI)(tacrolimus or cyclosporine A) plus mycophenolate mofetil (PTCy/TAC or CSA/MMF) and anti-thymocyte globulin plus CNI (tacrolimus or cyclosporine A) plus methotrexate (ATG/TAC or CSA/MTX) are common graft-versus-host disease (GVHD) prophylaxis regimens. We compared the two regimens in patients with acute myeloid leukemia (AML) undergoing allogeneic transplantation from matched siblings or unrelated donors. 402 received PTCy/TAC or CSA/MMF and 5648 received ATG/TAC or CSA/MTX. Patients in the PTCy-based group were younger (48.7 vs. 51.5 years, p = 0.024) and there was a higher frequency of patient cytomegalovirus seropositivity and female donor to male patient combination in this group (77.8% vs. 71.8%, p = 0.009 and 18.4% vs. 14.4%, p = 0.029, respectively). More patients in the PTCy-based group received reduced-intensity conditioning (51.5% vs. 41%, p < 0.0001). No differences were observed in the incidence of acute GVHD grade II-IV and III-IV (21.2% vs. 20.4%, p = 0.92 and 8.1% vs. 6%, p = 0.1) or 2-year total and extensive chronic GVHD (33.7% vs. 30%, p = 0.09 and 10.7% vs. 11.2%, p = 0.81) between the groups. In the multivariate analysis, all transplant outcomes did not differ between the groups. PTCy/CNI/MMF and ATG/CNI/MTX are alternative regimens for GVHD prophylaxis in AML patients.
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Affiliation(s)
- Arnon Nagler
- Division of Hematology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
| | - Myriam Labopin
- EBMT Paris Study Office; Department of Haematology, Saint Antoine Hospital; INSERM UMR 938, Sorbonne University, Paris, France
- Department of Haematology, Saint Antoine Hospital, Sorbonne University; INSERM UMR 938, Paris, France
| | - Ryszard Swoboda
- Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | | | | | | | | | - Alessandro Rambaldi
- Department of Oncology and Hematology, University of Milan and Azienda Socio-Sanitaria Territoriale, Papa Giovanni XXIII, Bergamo, Italy
| | | | - Alexander Kulagin
- RM Gorbacheva Research Institute, Pavlov University, Petersburg, Russia
| | | | - Thomas Luft
- University of Heidelberg, Heidelberg, Germany
| | | | | | | | | | | | - Alexandros Spyridonidis
- Department of Internal Medicine, Bone Marrow Transplantation Unit, University Hospital of Patras, Patras, Greece
| | - Eolia Brissot
- Department of Haematology, Saint Antoine Hospital, Sorbonne University; INSERM UMR 938, Paris, France
| | - Fabio Ciceri
- Department of Haematology and BMT, IRCCS Osspedale San Raffaele; Vita-Salute San Raffaele University, Milano, Italy
| | - Mohamad Mohty
- EBMT Paris Study Office; Department of Haematology, Saint Antoine Hospital; INSERM UMR 938, Sorbonne University, Paris, France
- Department of Haematology, Saint Antoine Hospital, Sorbonne University; INSERM UMR 938, Paris, France
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5
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Nagler A, Ngoya M, Galimard JE, Labopin M, Blau IW, Kröger N, Gedde-Dahl T, Schroeder T, Burns D, Salmenniemi U, Rambaldi A, Choi G, Peffault de Latour R, Vydra J, Sengeloev H, Eder M, Mielke S, Forcade E, Kulagin A, Ciceri F, Mohty M. Comparable relapse incidence after unrelated allogeneic stem cell transplantation with post-transplant cyclophosphamide versus conventional anti-graft versus host disease prophylaxis in patients with acute myeloid leukemia: A study on behalf of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Am J Hematol 2024. [PMID: 38856236 DOI: 10.1002/ajh.27383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/06/2024] [Accepted: 05/20/2024] [Indexed: 06/11/2024]
Abstract
We compared relapse incidence (RI) post-unrelated transplantation with post-transplant cyclophosphamide (PTCy) versus no PTCy graft-versus-host disease (GVHD) prophylaxis, in 7049 acute myeloid leukemia (AML) patients in remission, 707 with PTCy, and 6342 without (No PTCy). The patients in the PTCy group were younger, 52.7 versus 56.6 years (p < .001). There were more 9/10 donors in the PTCy group, 33.8% versus 16.4% (p < .001), and more received myeloablative conditioning, 61.7% versus 50.2% (p < .001). In the No PTCy group, 87.7% of patients received in vivo T-cell depletion. Neutrophil and platelet engraftment were lower in the PTCy versus No PTCy group, 93.8% and 80.9% versus 97.6% and 92.6% (p < .001). RI was not significantly different in the PTCy versus the No PTCy group, hazard ratio (HR) of 1.11 (95% confidence interval [CI] 0.9-1.37) (p = .31). Acute GVHD grades II-IV and III-IV, were significantly lower in the PTCy versus the No PTCy group, HR of 0.74 (95% CI 0.59-0.92, p = .007) and HR = 0.56 (95% CI 0.38-0.83, p = .004), as were total and extensive chronic GVHD, HRs of 0.5 (95% CI 0.41-0.62, p < .001) and HR = 0.31 (95% CI 0.22-0.42, p < .001). Non-relapse mortality (NRM) was significantly lower with PTCy versus the No PTCy group, HR of 0.67 (95% CI 0.5-0.91, p = .007). GVHD-free, relapse-free survival (GRFS) was higher in the PTCy versus the No PTCy group, HR of 0.69 (95% CI 0.59-0.81, p = .001). Leukemia-free survival (LFS) and overall survival (OS) did not differ between the groups. In summary, we observed comparable RI, OS, and LFS, significantly lower incidences of GVHD and NRM, and significantly higher GRFS in AML patients undergoing unrelated donor-hematopoietic stem cell transplantation with PTCy versus No PTCy GVHD prophylaxis.
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Affiliation(s)
- Arnon Nagler
- Division of Hematology, Sheba Medical Center, Tel Hashomer, Israel
| | - Maud Ngoya
- EBMT Paris Study Office, Department of Haematology, Saint Antoine Hospital, INSERM UMR 938, Sorbonne University, Paris, France
- Department of Haematology, Saint Antoine Hospital, INSERM UMR 938, Sorbonne University, Paris, France
| | | | - Myriam Labopin
- EBMT Paris Study Office, Department of Haematology, Saint Antoine Hospital, INSERM UMR 938, Sorbonne University, Paris, France
- Department of Haematology, Saint Antoine Hospital, INSERM UMR 938, Sorbonne University, Paris, France
| | - Igor Wolfgang Blau
- Medizinische Klinik m. S. Hämatologie, Onkologie und Tumorimmunologie, Berlin, Germany
| | | | | | | | - David Burns
- University Hospital Birmingham NHSTrust, Birmingham, UK
| | | | - Alessandro Rambaldi
- Department of Oncology and Hematology, University of Milan and Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII Piazza OMS, Bergamo, Italy
| | - Goda Choi
- University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | | | - Jan Vydra
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | | | | | | | | | - Alexander Kulagin
- RM Gorbacheva Research Institute, Pavlov University, Petersburg, Russia
| | - Fabio Ciceri
- IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Mohamad Mohty
- EBMT Paris Study Office, Department of Haematology, Saint Antoine Hospital, INSERM UMR 938, Sorbonne University, Paris, France
- Department of Haematology, Saint Antoine Hospital, INSERM UMR 938, Sorbonne University, Paris, France
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6
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Beelen DW, Iacobelli S, Koster L, Eikema DJ, van Biezen A, Stölzel F, Ciceri F, Bethge W, Dreger P, Wagner-Drouet EM, Reményi P, Stelljes M, Markiewicz M, McLornan DP, Yakoub-Agha I, Mohty M. Fludarabine-treosulfan versus fludarabine-melphalan or busulfan-cyclophosphamide conditioning in older AML or MDS patients - A clinical trial to registry data comparison. Bone Marrow Transplant 2024; 59:670-679. [PMID: 38383713 PMCID: PMC11073976 DOI: 10.1038/s41409-024-02241-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 02/23/2024]
Abstract
A randomized study (acronym: MC-FludT.14/L Trial II) demonstrated that fludarabine plus treosulfan (30 g/m²) was an effective and well tolerated conditioning regimen for allogeneic hematopoietic cell transplantation (allo-HCT) in older patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). To further evaluate this regimen, all 252 study patients aged 50 to 70 years were compared with similar patients, who underwent allo-HCT after fludarabine/melphalan (140 mg/m²) (FluMel) or busulfan (12.8 mg/kg)/cyclophosphamide (120 mg/kg) (BuCy) regimens and whose data was provided by the European Society for Blood and Marrow Transplantation registry. In 1:1 propensity-score matched-paired analysis (PSA) of AML patients, there was no difference in 2-year-relapse-incidence after FluTreo compared with either FluMel (n = 110, p = 0.28) or BuCy (n = 78, p = 0.98). However, 2-year-non-relapse-mortality (NRM) was lower compared with FluMel (p = 0.019) and BuCy (p < 0.001). Consequently, 2-year-overall-survival (OS) after FluTreo was higher compared with FluMel (p = 0.04) and BuCy (p < 0.001). For MDS patients, no endpoint differences between FluTreo and FluMel (n = 30) were evident, whereas 2-year-OS after FluTreo was higher compared with BuCy (n = 25, p = 0.01) due to lower 2-year-NRM. Multivariate sensitivity analysis confirmed all significant results of PSA. Consequently, FluTreo (30 g/m²) seems to retain efficacy compared with FluMel and BuCy, but is better tolerated by older patients.
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Affiliation(s)
- Dietrich Wilhelm Beelen
- Department of Haematology and Stem Cell Transplantation, West German Cancer Center, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany.
| | - Simona Iacobelli
- Department of Biology, University Tor Vergata of Rome, Rome, Italy
| | - Linda Koster
- EBMT Data Office Leiden, Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, Netherlands
| | - Dirk-Jan Eikema
- EBMT Data Office Leiden, Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, Netherlands
| | - Anja van Biezen
- EBMT Data Office Leiden, Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, Netherlands
| | - Friedrich Stölzel
- Division of Stem Cell Transplantation and Cellular Immunotherapies, Department of Internal Medicine 2, University Hospital Schleswig-Holstein, Kiel, Kiel University, Kiel, Germany
- Faculty of Medicine Carl Gustav Carus Dresden, Technical University Dresden, Dresden, Germany
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Wolfgang Bethge
- Department of Hematology and Oncology, University Hospital Tübingen, Tübingen, Germany
| | - Peter Dreger
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Eva-Maria Wagner-Drouet
- Third Department of Medicine - Hematology, Internal Oncology & Pneumology, Johannes Gutenberg-University Medical Center, Mainz, Germany
| | - Péter Reményi
- St. István and St. László Hospital of Budapest, Budapest, Hungary
| | - Matthias Stelljes
- Department of Medicine A, Hematology, Oncology, Hemostaseology and Pneumology, University Hospital Münster, Münster, Germany
| | - Miroslaw Markiewicz
- Department of Hematology, Institute of Medical Sciences, College of Medical Sciences, University of Rzeszow, Rzeszow, Poland
| | | | - Ibrahim Yakoub-Agha
- Centre Hospitalier Universitaire de Lille, Université Lille, INSERM U1286, Infinite, Lille, France
| | - Mohamad Mohty
- Hospital Saint-Antoine, Sorbonne Université, Centre de Recherche Saint-Antoine (CRSA), Paris, France
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7
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Loke J, Labopin M, Craddock C, Socié G, Gedde-Dahl T, Blaise D, Forcade E, Salmenniemi U, Huynh A, Versluis J, Yakoub-Agha I, Labussière-Wallet H, Maertens J, Passweg J, Bulabois CE, Gabellier L, Mielke S, Castilla-Llorente C, Deconinck E, Brissot E, Nagler A, Ciceri F, Mohty M. Prognostic impact of number of induction courses to attain complete remission in patients with acute myeloid leukemia transplanted with either a matched sibling or human leucocyte antigen 10/10 or 9/10 unrelated donor: An Acute Leukemia Working Party European Society for Blood and Marrow Transplantation study. Cancer 2024. [PMID: 38581695 DOI: 10.1002/cncr.35308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 04/08/2024]
Abstract
INTRODUCTION For the majority of patients with acute myeloid leukemia (AML) an allogeneic stem cell transplant (SCT) in first complete remission (CR) is preferred. However, whether the number of courses required to achieve CR has a prognostic impact is unclear. It is unknown which factors remain important in patients requiring more than one course of induction to attain remission. METHODS This Acute Leukaemia Working Party study from the European Society for Blood and Marrow Transplantation identified adults who received an allograft in first CR from either a fully matched sibling or 10/10 or 9/10 human leucocyte antigen (HLA)-matched unrelated donor (HLA-A, HLA-B, HLA-C, HLA-DR, or HLA-DQ). Univariate and multivariate analyses were undertaken to identify the prognostic impact of one or two courses of induction to attain CR. RESULTS A total of 4995 patients were included with 3839 (77%) patients attaining a CR following one course of induction chemotherapy (IND1), and 1116 patients requiring two courses (IND2) to attain CR. IND2 as compared to IND1 was a poor prognostic factor in a univariate analysis and remained so in a multivariate Cox model, resulting in an increased hazard ratio of relapse (1.38; 95% confidence interval [CI], 1.16-1.64; p = .0003) and of death (1.27; 95% CI, 1.09-1.47; p = .002). Adverse prognostic factors in a multivariate analysis of the outcomes of patients requiring IND2 included age, FLT3-ITD, adverse cytogenetics, and performance status. Pretransplant measurable residual disease retained a prognostic impact regardless of IND1 or IND2. CONCLUSION Initial response to chemotherapy as determined by number of courses to attain CR, retained prognostic relevance even following SCT in CR.
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Affiliation(s)
- Justin Loke
- University of Birmingham, Birmingham, UK
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Myriam Labopin
- Acute Leukaemia Working Party, Paris Study Office, European Society for Blood and Marrow Transplantation, Paris, France
- Hematology Department, AP-HP, Sorbonne Universités, INSERM, Centre de Recherche Saint-Antoine (CRSA), Saint Antoine Hospital, Paris, France
| | - Charles Craddock
- Birmingham Centre for Cellular Therapy and Transplantation, Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK
- University of Warwick, Warwick, UK
| | - Gérard Socié
- Department of Hematology-BMT, Hopital St. Louis, Paris, France
| | - Tobias Gedde-Dahl
- Hematology Department, Oslo University Hospital, Rikshospitalet Clinic for Cancer Medicine, Oslo, Norway
| | - Didier Blaise
- Programme de Transplantation & Therapie Cellulaire Centre de Recherche en Cancérologie de Marseille, Marseille, France
| | | | - Urpu Salmenniemi
- HUCH Comprehensive Cancer Center, Stem Cell Transplantation Unit, Helsinki, Finland
| | - Anne Huynh
- CHU-Institut Universitaire du Cancer Toulouse, Oncopole, Toulouse, France
| | - Jurjen Versluis
- Erasmus MC Cancer Institute University Medical Center, Rotterdam, Netherlands
| | | | | | - Johan Maertens
- Department of Hematology, University Hospital Gasthuisberg, Leuven, Belgium
| | | | | | - Ludovic Gabellier
- Département d`Hématologie Clinique, CHU Lapeyronie, Montpellier, France
| | - Stephan Mielke
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Eric Deconinck
- Université de Franche-Comté, EFS, INSERM, UMR RIGHT, Besançon, France
- Hématologie, CHU Besançon, Besançon, France
| | - Eolia Brissot
- Hematology Department, AP-HP, Sorbonne Universités, INSERM, Centre de Recherche Saint-Antoine (CRSA), Saint Antoine Hospital, Paris, France
| | - Arnon Nagler
- Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation Unit, Università Vita Salute San Raffaele, Milan, Italy
| | - Mohamad Mohty
- Hematology Department, AP-HP, Sorbonne Universités, INSERM, Centre de Recherche Saint-Antoine (CRSA), Saint Antoine Hospital, Paris, France
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8
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Adkins BD, Jacobs JW, Booth GS, Savani BN, Stephens LD. Transfusion Support in Hematopoietic Stem Cell Transplantation: A Contemporary Narrative Review. Clin Hematol Int 2024; 6:128-140. [PMID: 38817704 PMCID: PMC11086996 DOI: 10.46989/001c.94135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/05/2024] [Indexed: 06/01/2024] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) is a cornerstone of modern medical practice, and can only be performed safely and effectively with appropriate transfusion medicine support. Patients undergoing HSCT often develop therapy-related cytopenia, necessitating differing blood product requirements in the pre-, peri-, and post-transplant periods. Moreover, ensuring optimal management for patients alloimmunized to human leukocyte antigens (HLA) and/or red blood cell (RBC) antigens, as well as for patients receiving ABO-incompatible transplants, requires close collaboration with transfusion medicine and blood bank professionals. Finally, as updated transfusion guidelines and novel blood product modifications emerge, the options available to the transplant practitioner continue to expand. Herein, we detail contemporary blood transfusion and transfusion medicine practices for patients undergoing HSCT.
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Affiliation(s)
- Brian D. Adkins
- PathologyThe University of Texas Southwestern Medical Center
| | | | - Garrett S. Booth
- Pathology, Microbiology, and ImmunologyVanderbilt University Medical Center
| | - Bipin N. Savani
- Internal Medicine, Division of Hematology/ OncologyVanderbilt University Medical Center
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9
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Paviglianiti A, Maia T, Gozlan JM, Brissot E, Malard F, Banet A, Van de Wyngaert Z, Ledraa T, Belhocine R, Sestili S, Capes A, Stocker N, Bonnin A, Vekhoff A, Legrand O, Mohty M, Duléry R. Human herpesvirus type 6 reactivation after haploidentical hematopoietic cell transplantation with post-transplant cyclophosphamide and antithymocyte globulin: risk factors and clinical impact. Clin Hematol Int 2024; 6:26-38. [PMID: 38817703 PMCID: PMC11087003 DOI: 10.46989/001c.92525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 10/16/2023] [Indexed: 06/01/2024] Open
Abstract
Human herpesvirus type 6 (HHV6) reactivation after haploidentical hematopoietic cell transplantation (HCT) with post-transplant cyclophosphamide (PT-Cy) has been scarcely studied, especially when antithymocyte globulin (ATG) is added to the graft-versus-host disease (GvHD) prophylaxis. We conducted a retrospective cohort study in 100 consecutive patients receiving haploidentical HCT with PT-Cy. We systematically monitored HHV6 DNA loads in blood samples on a weekly basis using quantitative PCR until day +100. The 100-day cumulative incidence of HHV6 reactivation was 54%. Clinically significant HHV6 infections were rare (7%), associated with higher HHV6 DNA loads, and had favorable outcomes after antiviral therapy. The main risk factor for HHV6 reactivation was a low absolute lymphocyte count (ALC) \< 290/µL on day +30 (68% versus 40%, p = 0.003). Adding ATG to PT-Cy did not increase the incidence of HHV6 reactivation (52% with ATG versus 79% without ATG, p = 0.12). Patients experiencing HHV6 reactivation demonstrated delayed platelet recovery (HR 1.81, 95% CI 1.07-3.05, p = 0.026), higher risk of acute grade II-IV GvHD (39% versus 9%, p \< 0.001) but similar overall survival and non-relapse mortality to the other patients. In conclusion, our findings endorse the safety of combining ATG and PT-Cy in terms of the risk of HHV6 reactivation and infection in patients undergoing haploidentical HCT. Patients with a low ALC on day +30 face a higher risk of HHV6 reactivation and may require careful monitoring.
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Affiliation(s)
- Annalisa Paviglianiti
- HematologySorbonne University
- Università Campus Bio-Medico
- Clinical HematologyInstitut Català d’Oncologia
- Clinical Hematology and Cellular Therapy, Hôpital Saint-Antoine, Assistance Publique - Hôpitaux de Paris
| | - Tânia Maia
- HematologySorbonne University
- Clinical Hematology and Cellular Therapy, Hôpital Saint-Antoine, Assistance Publique - Hôpitaux de Paris
- Clinical HematologyHospital de São João
| | - Joël-Meyer Gozlan
- VirologySorbonne University
- Virology, Hôpital Saint-Antoine, Assistance Publique - Hôpitaux de Paris
| | - Eolia Brissot
- HematologySorbonne University
- Clinical Hematology and Cellular Therapy, Hôpital Saint-Antoine, Assistance Publique - Hôpitaux de Paris
- INSERM, UMRs 938Centre de Recherche Saint-Antoine
| | - Florent Malard
- HematologySorbonne University
- Clinical Hematology and Cellular Therapy, Hôpital Saint-Antoine, Assistance Publique - Hôpitaux de Paris
- INSERM, UMRs 938Centre de Recherche Saint-Antoine
| | - Anne Banet
- HematologySorbonne University
- Clinical Hematology and Cellular Therapy, Hôpital Saint-Antoine, Assistance Publique - Hôpitaux de Paris
| | - Zoé Van de Wyngaert
- HematologySorbonne University
- Clinical Hematology and Cellular Therapy, Hôpital Saint-Antoine, Assistance Publique - Hôpitaux de Paris
| | - Tounes Ledraa
- HematologySorbonne University
- Clinical Hematology and Cellular Therapy, Hôpital Saint-Antoine, Assistance Publique - Hôpitaux de Paris
| | - Ramdane Belhocine
- HematologySorbonne University
- Clinical Hematology and Cellular Therapy, Hôpital Saint-Antoine, Assistance Publique - Hôpitaux de Paris
| | - Simona Sestili
- HematologySorbonne University
- Clinical Hematology and Cellular Therapy, Hôpital Saint-Antoine, Assistance Publique - Hôpitaux de Paris
| | - Antoine Capes
- HematologySorbonne University
- Clinical Hematology and Cellular Therapy, Hôpital Saint-Antoine, Assistance Publique - Hôpitaux de Paris
| | - Nicolas Stocker
- HematologySorbonne University
- Clinical Hematology and Cellular Therapy, Hôpital Saint-Antoine, Assistance Publique - Hôpitaux de Paris
- INSERM, UMRs 938Centre de Recherche Saint-Antoine
| | - Agnès Bonnin
- HematologySorbonne University
- Clinical Hematology and Cellular Therapy, Hôpital Saint-Antoine, Assistance Publique - Hôpitaux de Paris
| | - Anne Vekhoff
- HematologySorbonne University
- Clinical Hematology and Cellular Therapy, Hôpital Saint-Antoine, Assistance Publique - Hôpitaux de Paris
| | - Ollivier Legrand
- HematologySorbonne University
- Clinical Hematology and Cellular Therapy, Hôpital Saint-Antoine, Assistance Publique - Hôpitaux de Paris
| | - Mohamad Mohty
- HematologySorbonne University
- Clinical Hematology and Cellular Therapy, Hôpital Saint-Antoine, Assistance Publique - Hôpitaux de Paris
- INSERM, UMRs 938Centre de Recherche Saint-Antoine
| | - Rémy Duléry
- HematologySorbonne University
- Clinical Hematology and Cellular Therapy, Hôpital Saint-Antoine, Assistance Publique - Hôpitaux de Paris
- INSERM, UMRs 938Centre de Recherche Saint-Antoine
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10
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Spyridonidis A, Labopin M, Gedde-Dahl T, Ganser A, Stelljes M, Craddock C, Wagner-Drouet EM, Versluis J, Schroeder T, Blau IW, Wulf GG, Dreger P, Olesen G, Sengeloev H, Kröger N, Potter V, Forcade E, Passweg J, de Latour RP, Maertens J, Wilson KMO, Bourhis JH, Finke J, Brissot E, Bazarbachi A, Giebel S, Savani BP, Nagler A, Ciceri F, Mohty M. Validation of the transplant conditioning intensity (TCI) index for allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2024; 59:217-223. [PMID: 37978322 PMCID: PMC10849946 DOI: 10.1038/s41409-023-02139-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 10/05/2023] [Accepted: 10/18/2023] [Indexed: 11/19/2023]
Abstract
The intensity of the conditioning regimen given before allogeneic hematopoietic cell transplantation (allo-HCT) can vary substantially. To confirm the ability of the recently developed transplant conditioning intensity (TCI) score to stratify the preparative regimens of allo-HCT, we used an independent and contemporary patient cohort of 4060 transplant recipients with acute myeloid leukemia meeting inclusion criteria from the discovery study (allo-HCT in first complete remission, matched donor), but who were allografted in a more recent period (2018-2021) and were one decade older (55-75 years, median 63.4 years), we assigned them to a TCI category (low n = 1934, 48%; intermediate n = 1948, 48%, high n = 178, 4%) according to the calculated TCI score ([1-2], [2.5-3.5], [4-6], respectively), and examined the validity of the TCI category in predicting early non-relapse mortality (NRM), 2-year NRM and relapse (REL). In the unadjusted comparison, the TCI index provided a significant risk stratification for d100 and d180 NRM, NRM and REL risk. In the multivariate analysis adjusted for significant variables, there was an independent association of TCI with early NRM, NRM and REL. In summary, we confirm in contemporary treated patients that TCI reflects the conditioning regimen related morbidity and anti-leukemic efficacy satisfactorily and across other established prognostic factors.
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Affiliation(s)
- Alexandros Spyridonidis
- Bone Marrow Transplantation Unit and Institute of Cellular Therapy, University of Patras, Patras, Greece.
| | - Myriam Labopin
- EBMT Unit, Sorbonne University, Saint-Antoine Hospital, AP-HP, INSERM UMRs 938, Paris, France
| | - Tobias Gedde-Dahl
- Oslo University Hospital, Rikshospitalet Clinic for Cancer Medicine, Hematology Dept. Section for Stem Cell Transplantation, Oslo, Norway
| | - Arnold Ganser
- Hannover Medical School, Department of Haematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover, Germany
| | | | - Charles Craddock
- University Hospital Birmingham NHSTrust, Queen Elizabeth Medical Centre, Edgbaston, Dept. of Haematology, Birmingham, United Kingdom
| | - Eva Maria Wagner-Drouet
- University Medical Center Mainz, Department of Hematology, Oncology and Pneumology, Mainz, Germany
| | - Jurjen Versluis
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Hematology, Rotterdam, Netherlands
| | - Thomas Schroeder
- University Hospital Essen, Dept. of Bone Marrow Transplantation, Essen, Germany
| | - Igor Wolfgang Blau
- Charité Universitätsmedizin Berlin, Onkologie und Tumorimmunologie, Berlin, Germany
| | - Gerald G Wulf
- Universitaetsklinikum Goettingen, Abteilung Hämatologie und Onkologie, Goettingen, Germany
| | - Peter Dreger
- University of Heidelberg, Medizinische Klinik u. Poliklinik V, Heidelberg, Germany
| | | | - Henrik Sengeloev
- National University Hospital, Bone Marrow Transplant Unit, Copenhagen, Denmark
| | - Nicolaus Kröger
- University Hospital Eppendorf, Bone Marrow Transplantation Centre, Hamburg, Germany
| | - Victoria Potter
- Kings College Hospital, Dept. of Haematological Medicine, King's Denmark Hill Campus, London, United Kingdom
| | | | - Jakob Passweg
- University Hospital Basel, Dept of Hematology, Basel, Switzerland
| | | | - Johan Maertens
- University Hospital Gasthuisberg Dept. of Hematology, Leuven, Belgium
| | - Keith M O Wilson
- University Hospital of Wales, Department of Haematology, Cardiff, United Kingdom
| | - Jean Henri Bourhis
- Gustave Roussy Cancer Campus, Department of Hematology, Villejuif, France
| | - Juergen Finke
- University of Freiburg, Department of Hematology/Oncology, Freiburg, Germany
| | - Eolia Brissot
- Hospital Saint Antoine, Department of Hematology, Paris, France
| | - Ali Bazarbachi
- American University of Beirut-Medical Center, Department of Internal Medicine-Bone Marrow Transplantation Program, Beirut, Lebanon
| | - Sebastian Giebel
- Maria Sklodowska-Curie National Research Institute of Oncology, Department of Hematology, Gliwice, Poland
| | - Bipin P Savani
- Vanderbilt University Medical Center, Department of Hematology, Nashville, TN, USA
| | - Arnon Nagler
- Chaim Sheba Medical Center, Department of Hematology, Tel-Hashomer, Israel
| | - Fabio Ciceri
- Hematology Division, Ospedale San Raffaele s.r.l., Haematology and BMT, Milano, Italy
| | - Mohamad Mohty
- EBMT Unit, Sorbonne University, Saint-Antoine Hospital, AP-HP, INSERM UMRs 938, Paris, France
- Hospital Saint Antoine, Department of Hematology, Paris, France
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11
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Duque-Afonso J, Finke J, Ngoya M, Galimard JE, Craddock C, Raj K, Bloor A, Nicholson E, Eder M, Kim O, Valerius T, Snowden JA, Tholouli E, Crawley C, Collin M, Wilson KMO, Gadisseur A, Protheroe R, Wagner-Drouet EM, Savani BN, Spyridonidis A, Ciceri F, Nagler A, Mohty M. Comparison of fludarabine/melphalan (FluMel) with fludarabine/melphalan/BCNU or thiotepa (FBM/FTM) in patients with AML in first complete remission undergoing allogeneic hematopoietic stem cell transplantation - a registry study on behalf of the EBMT Acute Leukemia Working Party. Bone Marrow Transplant 2024; 59:247-254. [PMID: 38040842 PMCID: PMC10849951 DOI: 10.1038/s41409-023-02150-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/26/2023] [Accepted: 11/07/2023] [Indexed: 12/03/2023]
Abstract
Conditioning protocols for patients undergoing allogeneic hematopoietic cell transplantation (allo-HCT) are being developed continuously to improve their anti-leukemic efficacy and reduce their toxicity. In this study, we compared the conditioning protocol of fludarabine with melphalan 140 mg/m2 (FluMel) with conditioning protocols based on this same backbone but with an additional alkylating agent i.e., either fludarabine/BCNU (also known as carmustine)/melphalan (FBM), or fludarabine/thiotepa/melphalan (FTM) 110 mg/m2. We included 1272 adult patients (FluMel, n = 1002; FBM/FTM, n = 270) with acute myeloid leukemia (AML) with intermediate/poor cytogenetic risk in first complete remission (CR) from the registry of the EBMT Acute Leukemia Working Party. Despite patients in the FBM/FTM group were older (64.1 years vs. 59.8 years, p < 0.001) and had a worse Karnofsky performance score (KPS < 90, 33% vs. 24%, p = 0.003), they showed a better overall survival (OS) (2 y OS: 68.3% vs. 58.1%, p = 0.02) and less non-relapse mortality (NRM) (2 y NRM: 15.8% vs. 22.2%, p = 0.009) compared to patients treated with FluMel. No significant differences were observed in relapse incidence (RI) (2 y RI: 24.9% vs. 23.7%, p = 0.62). In conclusion, the addition of a second alkylating agent (BCNU/carmustine or thiotepa) to FluMel as FBM/FTM conditioning, improves OS in AML patients in first CR with intermediate/poor risk cytogenetics after allo-HCT.
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Affiliation(s)
- Jesús Duque-Afonso
- Department of Hematology/Oncology, Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany.
| | - Jürgen Finke
- Department of Hematology/Oncology, Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany
| | - Maud Ngoya
- EBMT Statistical Unit, INSERM UMRs 938, Hôpital Saint Antoine, Paris, France
| | | | - Charles Craddock
- Birmingham Centre for Cellular Therapy and Transplantation, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
| | - Kavita Raj
- Department of Haematology, University College London Hospital, London, UK
| | - Adrian Bloor
- The Christie NHS Foundation Trust, Stem Cell Transplantation Unit, University of Manchester, Manchester, UK
| | - Emma Nicholson
- Department of Haematology, Royal Marsden Hospital, London, UK
| | - Matthias Eder
- Department of Haematology, Hannover Medical School, Hemostasis, Oncology and Stem Cell Transplantation, Hannover, Germany
| | - Orchard Kim
- Department of Haematology, Southampton General Hospital, Haematology, Oncology & Paediatrics, Southampton, UK
| | - Thomas Valerius
- Department of Medicine II, University Medical Center Schleswig-Holstein, Campus Kiel, Section of Stem Cell Transplantation and Immunotherapy, Kiel, Germany
| | - John A Snowden
- Department of Hematology, Sheffield Teaching Hospitals NHS Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Eleni Tholouli
- Clinical Haematology Department, Manchester Royal Infirmary, Manchester, UK
| | - Charles Crawley
- Department of Haematology, Addenbrookes Hospital, Cambridge, UK
| | - Matthew Collin
- Adult HSCT unit, Northern Centre for Bone Marrow Transplantation, Freeman Hospital, Newcastle Tyne, UK
| | - Keith M O Wilson
- Department of Haematology, University Hospital of Wales, Cardiff, UK
| | - Alain Gadisseur
- Department of Hematology, Antwerp University Hospital (UZA), Antwerp Edegem, Belgium
| | - Rachel Protheroe
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Eva Maria Wagner-Drouet
- Department of Hematology, University Medical Center Mainz, Oncology and Pneumology, Mainz, Germany
| | - Bipin N Savani
- Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Fabio Ciceri
- University Vita-Salute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Arnon Nagler
- Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Mohamad Mohty
- Sorbonne University, Saint-Antoine Hospital, AP-HP, INSERM UMRs 938, Paris, France.
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12
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Nagler A, Labopin M, Kröger N, Schroeder T, Gedde-Dahl T, Eder M, Franke GN, Blau IW, Salmenniemi U, Socie G, Schetelig J, Stelljes M, Ciceri F, Mohty M. The role of anti-thymocyte globulin in allogeneic stem cell transplantation (HSCT) from HLA-matched unrelated donors (MUD) for secondary AML in remission: a study from the ALWP /EBMT. Bone Marrow Transplant 2023; 58:1339-1347. [PMID: 37660157 DOI: 10.1038/s41409-023-02095-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/09/2023] [Accepted: 08/18/2023] [Indexed: 09/04/2023]
Abstract
We compared outcomes, of 1609 patients with secondary acute myeloid leukemia (sAML) undergoing allogeneic transplantation (HSCT) in first complete remission (CR1) from matched unrelated donors (MUD) from 2010 to 2021, receiving or not receiving anti-thymocyte globulin (ATG) (ATG-1308, no ATG-301). Median age was 60.9 (range, 18.5-77.8) and 61.1 (range, 21.8-75.7) years, (p = 0.3). Graft versus host disease (GVHD) prophylaxis was cyclosporin-A with methotrexate (41%) or mycophenolate mofetil (38.2%), without significant differences between groups. Day 28, engraftment (ANC > 0.5 × 109/L) was 92.3% vs 95.3% (p = 0.17), respectively. On multivariate analysis, ATG was associated with lower incidence of grade II-IV and grade III-IV acute GVHD (p = 0.002 and p = 0.015), total and extensive chronic GVHD (p = 0.008 and p < 0.0001), and relapse incidence (RI) (p = 0.039), while non-relapse mortality (NRM) did not differ (p = 0.51). Overall survival (OS), and GVHD-free, relapse-free survival (GRFS) were significantly higher in the ATG vs no ATG group, HR = 0.76 (95% CI 0.61-0.95, p = 0.014) and HR = 0.68 (95% CI 0.57-0.8, p < 0.0001), with a tendency for better leukemia-free survival (LFS), HR = 0.82 (95% CI 0.67-1, p = 0.051). The main causes of death were the original disease, infection, and GVHD. In conclusion, ATG reduces GVHD and improves LFS, OS, and GRFS in sAML patients without increasing the RI, despite sAML being a high-risk disease.
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Affiliation(s)
- Arnon Nagler
- Division of Hematology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
| | - Myriam Labopin
- EBMT Paris study office; Department of Haematology, Saint Antoine Hospital, Sorbonne University, INSERM UMR 938, Paris, France
- Sorbonne University, Department of Haematology, Saint Antoine Hospital; INSERM UMR 938, Paris, France
| | - Nicolaus Kröger
- Department of Stem Cell Transplantation, University Medical Center, Hamburg, Germany
| | - Thomas Schroeder
- University Hospital, Department of Bone Marrow Transplantation, Essen, Germany
| | - Tobias Gedde-Dahl
- Oslo University Hospital, Rikshospitalet Clinic for Cancer Medicine, Hematology Department, Section for Stem Cell Transplantation, Oslo, Norway
| | - Matthias Eder
- Hannover Medical School, Department of Haematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover, Germany
| | - Georg-Nikolaus Franke
- Medical Clinic and Policinic 1, Hematology and Cellular Therapy University hospital Leipzig, Leipzig, Germany
| | - Igor Wolfgang Blau
- Charité, University medicine Berlin, Department of Hematology, BMT Unit, Berlin, Germany
| | - Urpu Salmenniemi
- HUCH Comprehensive Cancer Center, Stem Cell Transplantation Unit, Helsinki, Finland
| | - Gerard Socie
- Hopital St. Louis, Department of Hematology-BMT, Paris, France
| | - Johannes Schetelig
- Universitaetsklinikum Dresden Medizinische Klinik und Poliklinik I, Dresden, Germany
| | - Matthias Stelljes
- University of Muenster Department of Hematol. /Oncol., Muenster, Germany
| | - Fabio Ciceri
- Hematology & Bone Marrow Transplant, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mohamad Mohty
- EBMT Paris study office; Department of Haematology, Saint Antoine Hospital, Sorbonne University, INSERM UMR 938, Paris, France
- Sorbonne University, Department of Haematology, Saint Antoine Hospital; INSERM UMR 938, Paris, France
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13
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Duléry R, Malard F, Brissot E, Banet A, Sestili S, Belhocine R, Calabro M, Van de Wyngaert Z, Bonnin A, Ledraa T, Legrand O, Labopin M, Capderou E, Cohen A, Ederhy S, Mohty M. Reduced post-transplant cyclophosphamide dose with antithymocyte globulin in peripheral blood stem cell haploidentical transplantation. Bone Marrow Transplant 2023; 58:1215-1222. [PMID: 37596473 DOI: 10.1038/s41409-023-02085-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 08/01/2023] [Accepted: 08/09/2023] [Indexed: 08/20/2023]
Abstract
Post-transplant cyclophosphamide (PT-Cy) is effective for graft-versus-host disease (GVHD) prophylaxis, but it may cause dose-dependent toxicities, particularly in frail patients. Therefore, we compared the outcomes with a reduced PT-Cy total dose (70 mg/kg) to those with the standard PT-Cy dose (100 mg/kg) in haploidentical hematopoietic cell transplantation (HCT) patients aged ≥ 65 years and those with cardiac comorbidities. All consecutive patients with a hematological malignancy receiving peripheral blood stem cells (PBSCs) after a thiotepa-based conditioning with low-dose antithymocyte globulin were included. Thirty-three patients received PT-Cy at 70 mg/kg and 25 at 100 mg/kg. PT-Cy dose reduction did not increase the risk of GVHD and was associated with faster neutrophil and platelet recovery, and lower cumulative incidences of bacteremia (38% versus 72%, p = 0.004) and cardiac complications (12% versus 44%, p = 0.028). At 2 years, GVHD-free, relapse-free survival (GRFS) was higher with the reduced dose compared to the standard dose (60% versus 33%, p = 0.04). In conclusion, reducing PT-Cy total dose to 70 mg/kg is a safe and valid approach for elderly patients and those with cardiac comorbidities underdoing haploidentical HCT with PBSCs and low-dose antithymocyte globulin. The reduced PT-Cy dose was associated with improved hematological count recovery, lower incidence of toxicities, and higher GRFS.
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Affiliation(s)
- Rémy Duléry
- Department of Clinical Hematology and Cellular Therapy, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
- INSERM, UMRs 938, Centre de recherche Saint Antoine (CRSA), Paris, France.
| | - Florent Malard
- Department of Clinical Hematology and Cellular Therapy, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM, UMRs 938, Centre de recherche Saint Antoine (CRSA), Paris, France
| | - Eolia Brissot
- Department of Clinical Hematology and Cellular Therapy, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM, UMRs 938, Centre de recherche Saint Antoine (CRSA), Paris, France
| | - Anne Banet
- Department of Clinical Hematology and Cellular Therapy, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Simona Sestili
- Department of Clinical Hematology and Cellular Therapy, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ramdane Belhocine
- Department of Clinical Hematology and Cellular Therapy, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Martina Calabro
- Department of Clinical Hematology and Cellular Therapy, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Zoé Van de Wyngaert
- Department of Clinical Hematology and Cellular Therapy, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Agnès Bonnin
- Department of Clinical Hematology and Cellular Therapy, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Tounes Ledraa
- Department of Clinical Hematology and Cellular Therapy, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ollivier Legrand
- Department of Clinical Hematology and Cellular Therapy, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM, UMRs 938, Centre de recherche Saint Antoine (CRSA), Paris, France
| | - Myriam Labopin
- Department of Clinical Hematology and Cellular Therapy, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Acute Leukemia Working Party, European Society for Blood and Marrow Transplantation (EBMT) Paris Study Office/CEREST-TC, Paris, France
| | - Elodie Capderou
- Sorbonne University, UNICO-GRECO Cardio Oncology Program, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ariel Cohen
- Sorbonne University, UNICO-GRECO Cardio Oncology Program, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Stéphane Ederhy
- Sorbonne University, UNICO-GRECO Cardio Oncology Program, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Mohamad Mohty
- Department of Clinical Hematology and Cellular Therapy, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM, UMRs 938, Centre de recherche Saint Antoine (CRSA), Paris, France
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14
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Gavriilaki E, Sakellari I, Labopin M, Bornhäuser M, Hamladji RM, Casper J, Edinger M, Zák P, Yakoub-Agha I, Ciceri F, Schroeder T, Zuckerman T, Kobbe G, Yeshurun M, Narni F, Finke J, Diez-Martin JL, Berceanu A, Hilgendorf I, Verbeek M, Olivieri A, Savani B, Spyridonidis A, Nagler A, Mohty M. Survival advantage of treosulfan plus fludarabine (FT14) compared to busulfan plus fludarabine (FB4) in active acute myeloid leukemia post allogeneic transplantation: an analysis from the European Society for Blood and Marrow Transplantation (EBMT) Acute Leukemia Working Party (ALWP). Bone Marrow Transplant 2023; 58:1084-1088. [PMID: 37420011 DOI: 10.1038/s41409-023-02028-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/02/2023] [Accepted: 06/26/2023] [Indexed: 07/09/2023]
Abstract
We compared FT14 (fludarabine 150-160 mg/m2, treosulfan 42 g/m2) versus FB4 (fludarabine 150-160 mg/m2, busulfan 12.8 mg/kg) in acute myeloid leukemia (AML) transplanted at primary refractory/relapsed disease. We retrospectively studied: (a) adults diagnosed with AML, (b) recipients of first allogeneic hematopoietic stem cell transplantation (HSCT) from unrelated/sibling donor (2010-2020), (c) HSCT with primary refractory/relapsed disease, (d) conditioning regimen with FT14 or FB4. We studied 346 patients, 113 transplanted with FT14, and 233 with FΒ4. FT14 patients were significantly older, more frequently had an unrelated donor and had received a lower dose of fludarabine. Cumulative incidence (CI) of acute graft-versus-host disease (GVHD) grade III-IV and extensive chronic GVHD was similar. With a median follow-up of 28.7 months, 2-year CI of relapse was 43.4% in FT14 versus 53.2% in FB4, while non-relapse mortality (NRM) was respectively 20.8% versus 22.6%. This led to 2-year leukemia-free survival (LFS) of 35.8% for FT14 versus 24.2% in FB4, and overall survival (OS) of 44.4% versus 34%. Adverse cytogenetics and conditioning regimen independently predicted CI of relapse. Furthermore, conditioning regimen was the only independent predictor of LFS, OS, and GVHD-free/relapse-free survival. Therefore, our real-world multicenter study suggests that FT14 is associated with better outcomes in primary refractory/relapsed AML.
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Affiliation(s)
- Eleni Gavriilaki
- Hematology Department-BMT Unit, G Papanikolaou Hospital, Thessaloniki, Greece.
| | - Ioanna Sakellari
- Hematology Department-BMT Unit, G Papanikolaou Hospital, Thessaloniki, Greece
| | - Myriam Labopin
- Service d' Hématologie Clinique et Thérapie Cellulaire, Hospital Saint-Antoine, Sorbonne Université, Centre de Recherche Saint-Antoine (CRSA), Paris, France
| | - Martin Bornhäuser
- University Hospital Dresden, Medizinische Klinik und Poliklinik I, TU, Dresden, Germany
| | - Rose-Marie Hamladji
- Centre Pierre et Marie Curie, Service Hématologie Greffe de Moëlle, Alger, Algeria
| | - Jochen Casper
- Klinikum Oldenburg, Abt. Onkologie/Hämatologie, Oldenburg, Germany
| | - Matthias Edinger
- Department. of Hematology and Oncology, University Regensburg, Regensburg, Germany
| | - Pavel Zák
- Charles University Hospital, 4th Department of Internal Medicine - Hematology, Hradec_Kralove, Czech Republic
| | | | - Fabio Ciceri
- Ospedale San Raffaele s.r.l. Haematology and BMT, Milano, Italy
| | - Thomas Schroeder
- University Hospital Dept. of Bone Marrow Transplantation, Essen, Germany
| | - Tsila Zuckerman
- Dept. of Hematology & BMT, Rambam Medical Center, Haifa, Israel
| | - Guido Kobbe
- Heinrich Heine Universitaet, Klinik für Hämat,Onkol,Klin.Immun, Duesseldorf, Germany
| | - Moshe Yeshurun
- Hematology and BMT Department, Beilinson Hospital, Petach_Tikva, Israel
| | - Franco Narni
- Azienda Ospedaliero Universitaria di Modena Policlinico, Ematologia, Modena, Italy
| | - Jürgen Finke
- Department. of Medicine -Hematology, Oncology, University of Freiburg, Freiburg, Germany
| | | | - Ana Berceanu
- Hopital Jean Minjoz, Service d'Hématologie, Besancon, France
| | - Inken Hilgendorf
- Universitaetsklinikum Jena, Klinik für Innere Medizin II, (Abt. Hämatologie und Onkologie), Am Klinikum 1, Jena, Germany
| | - Mareike Verbeek
- Klinikum Rechts der Isar, III Med Klinik der TU, Munich, Germany
| | - Attilio Olivieri
- Azienda Ospedali Riuniti di Ancona, Department of Hematology, Ancona University, Ancona, Italy
| | - Bipin Savani
- Department of Hematology-Oncology, Vanderbilt University, Medical Center, Nashville, TN, USA
| | - Alexandros Spyridonidis
- Department of Internal Medicine, Bone Marrow Transplantation Unit, University Hospital of Patras, Patras, Greece
| | - Arnon Nagler
- Department of Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Mohamad Mohty
- Service d' Hématologie Clinique et Thérapie Cellulaire, Hospital Saint-Antoine, Sorbonne Université, Centre de Recherche Saint-Antoine (CRSA), Paris, France
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15
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Wegener A, Andersen NS, Friis LS, Petersen SL, Schjødt I, Kornblit B, Sengeløv H, Gjærde LK. Triple-Drug Graft-versus-Host Disease Prophylaxis after HLA-Matched Unrelated Donor Nonmyeloablative Allogenic Hematopoietic Stem Cell Transplantation. Transplant Cell Ther 2023; 29:575.e1-575.e6. [PMID: 37301257 DOI: 10.1016/j.jtct.2023.05.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Abstract
Adding sirolimus to graft-versus-host disease (GVHD) prophylaxis with cyclosporin and mycophenolate mofetil (MMF) reduced the risk of grade II-IV acute GVHD after nonmyeloablative (NMA) allogenic hematopoietic stem cell transplantation (HSCT) with an HLA-matched unrelated donor in a randomized clinical trial. We analyzed real-life data to investigate the impact of implementing the triple-drug regimen with cyclosporin, MMF and sirolimus as standard GVHD prophylaxis after NMA HSCT with an HLA-matched unrelated donor at our institution. We studied all adult patients (age ≥18 years) who underwent NMA HSCT with an HLA-matched unrelated donor at Rigshospitalet, Copenhagen University Hospital, Denmark between 2018 and 2021 and received GVHD prophylaxis with cyclosporin, MMF and sirolimus (triple-drug group [TDG]). Comparisons were made with a historical cohort who received tacrolimus and MMF as GVHD prophylaxis after HLA-matched unrelated donor NMA HSCT between 2014 and 2017 (control group [CG]). Outcomes were grade II-IV and grade III-IV acute GVHD, chronic GVHD, relapse, nonrelapse mortality (NRM) and overall survival (OS). A total of 264 patients were included (TDG, n = 137; CG, n = 127). Median age was 66 years (interquartile range [IQR], 58 to 69 years) in the TDG and 63 years (IQR, 57 to 68 years) in the CG. Acute myeloid leukemia and myelodysplastic syndrome were the most frequent indications for HSCT in both groups (TDG, 33% and 23%, respectively; CG, 36% and 22%, respectively). The cumulative incidence at day +110 of grade II-IV GVHD was 17% (95% confidence interval [CI] 11% to 23%) in the TDG versus 29% (95% CI, 21% to 37%) in the CG (P = .02, Gray's test) and that of grade III-IV acute GVHD was 3% (95% CI, 0 to 6%) versus 5% (95% CI, 1% to 8%), respectively (P = .4, Gray's test). In a Cox regression model adjusted for age, donor age and female donor to male recipient the risk of grade II-IV acute GVHD was lower in the TDG compared to the CG (hazard ratio [HR], .51; 95% CI .30 to .86; P = .01). The 2-year OS was 77% (95% CI, 70% to 84%) in the TDG and 69% (95% CI, 61% to 77%) in the CG (P = .04), and this difference remained significant after adjustment for age and Karnofsky Performance Status (HR, .65; 95% CI, .42 to .99; P = .04). The 2-year cumulative incidences of chronic GVHD, relapse and NRM were 60% (95% CI, 51% to 69%), 21% (95% CI, 13% to 28%), and 12% (95% CI, 6% to 17%), respectively, in the TDG and 62% (95% CI, 54% to 71%), 27% (95% CI, 19% to 35%) and 14% (95% CI, 8% to 20%), respectively, in the CG. Multivariable analyses revealed no difference in the risk of chronic GVHD (HR, .91; 95% CI, .65 to 1.26; P = .56), relapse (HR, .70; 95% CI, .42 to 1.15; P = .16) or NRM (HR, .56; 95% CI, .31 to 1.05; P = .07). After changing the standard GVHD prophylaxis in patients undergoing NMA HSCT with an HLA-matched unrelated donor from tacrolimus and MMF to cyclosporin, MMF and sirolimus, we observed a reduction in the incidence of grade II-IV acute GVHD and improved 2-year OS.
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Affiliation(s)
- Alma Wegener
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | | | - Lone Smidstrup Friis
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Søren Lykke Petersen
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ida Schjødt
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Brian Kornblit
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henrik Sengeløv
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Klingen Gjærde
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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16
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Nagler A, Labopin M, Swoboda R, Kulagin A, Velardi A, Sanz J, Labussière-Wallet H, Potter V, Kuball J, Sica S, Parovichnikova E, Bethge W, Maillard N, Platzbecker U, Stölzel F, Ciceri F, Mohty M. Long-term outcome of second allogeneic hematopoietic stem cell transplantation (HSCT2) for primary graft failure in patients with acute leukemia in remission: A study on behalf of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Bone Marrow Transplant 2023; 58:1008-1016. [PMID: 37253804 DOI: 10.1038/s41409-023-02012-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/07/2023] [Accepted: 05/15/2023] [Indexed: 06/01/2023]
Abstract
Second transplantation (HSCT2) is a potential treatment for primary graft failure (pGF). We assessed the outcome of HSCT2, performed between 2000 and 2021, for pGF in 243 patients with acute leukemia. Median age was 44.8 years. Conditioning at first HSCT (HSCT1) was myeloablative (MAC) in 58.4%. Median time from HSCT1 to HSCT2 was 48 days. Donors for HSCT2 were the same as for HSCT1 in 49%. Engraftment post HSCT2 was achieved by 73.7% of patients. The incidence of acute (a) graft versus host disease (GVHD) grades II-IV and III-IV was 23.2 and 8.1%. 5-year total and extensive chronic (c) GVHD was 22.3 and 10.1%. 5-year nonrelapse mortality (NRM), relapse incidence (RI), leukemia-free survival (LFS), overall survival (OS) and GVHD free, relapse-free survival (GRFS) was 51.6, 18.8, 29.6, 30.7 and 22.4%, respectively. Infections were the main cause of death. In multivariable analysis, being transplanted at second vs. first remission, lower Karnofsky performance status (KPS; <90) and receiving MAC at HSCT1 were adverse prognostic factors for NRM, LFS, OS, and GRFS, as was increased age for NRM, LFS, OS. We conclude that HSCT2 can rescue about a third of the patients who experienced pGF, but NRM is as high as 50%.
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Affiliation(s)
- Arnon Nagler
- Division of Hematology, Sheba Medical Center, Tel Hashomer, Israel.
| | - Myriam Labopin
- EBMT Paris study office; Department of Hematology, Saint Antoine Hospital; INSERM UMR 938, Sorbonne University, Paris, France
- Department of Hematology, Saint Antoine Hospital; INSERM UMR 938, Sorbonne University, Paris, France
| | - Ryszard Swoboda
- Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Alexander Kulagin
- First State Pavlov Medical University of St. Petersburg, Raisa Gorbacheva Memorial Research Institute for Paediatric Oncology, Hematology, and Transplantation, St Petersburg, Russia
| | - Andrea Velardi
- Sezione di Ematologia, Dipartimento di Medicina Clinica e Sperimentale, Università di Perugia, Ospedale Santa Maria della, Perugia, Italy
| | - Jaime Sanz
- Hematology Department, University Hospital La Fe, Valencia, Spain
| | | | - Victoria Potter
- Dept. of Haematological Medicine, Kings College Hospital, London, United Kingdom
| | - Jürgen Kuball
- University Medical Centre Dept. of Haematology, Utrecht, The Netherlands
| | - Simona Sica
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Elena Parovichnikova
- National Research Center for Hematology, Bone Marrow Transplantation, Moscow, Russia
| | - Wolfgang Bethge
- Universitaet Tuebingen, Medizinische Klinik, Tuebingen, Germany
| | - Natacha Maillard
- Hopital La Miletrie Bone Marrow TransplantUnit, Clinical Hematology, Poitiers, France
| | - Uwe Platzbecker
- Medical Clinic and Policinic 1, Hematology and Cellular Therapy, University hospital Leipzig, Leipzig, Germany
| | - Friedrich Stölzel
- Department of Hematology and Oncology, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
- Department of Medicine II, Division for Stem Cell Transplantation and Cellular Immunotherapy, University Hospital Schleswig-Holstein Kiel, Kiel University, Kiel, Germany
| | - Fabio Ciceri
- Ospedale San Raffaele s.r.l. Haematology and BMT, Milano, Italy
| | - Mohamad Mohty
- EBMT Paris study office; Department of Hematology, Saint Antoine Hospital; INSERM UMR 938, Sorbonne University, Paris, France
- Department of Hematology, Saint Antoine Hospital; INSERM UMR 938, Sorbonne University, Paris, France
- Department of Hematology, Hospital Saint Antoine, EBMT Paris Study Office/CEREST-TC, Saint Antoine Hospital, Paris, France
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17
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Maffini E, Ngoya M, Galimard JE, Harbi S, Kröger N, Platzbecker U, Sengeloev H, Craddock C, Potter V, Choi G, Chevallier P, Stölzel F, Tholouli E, Maertens J, Ciceri F, Cornelissen J, Sanz J, Spyridonidis A, Lanza F, Nagler A, Mohty M. Allogeneic hematopoietic cell transplantation for patients with AML aged 70 years or older in first remission. A study from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT). Bone Marrow Transplant 2023; 58:1033-1041. [PMID: 37386253 DOI: 10.1038/s41409-023-02027-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 06/04/2023] [Accepted: 06/21/2023] [Indexed: 07/01/2023]
Abstract
Accessibility to allogeneic hematopoietic cell transplantation (HCT) programs for older patients is growing constantly. We report on the clinical outcomes of a group of 701 adults aged ≥70 years, with acute myeloid leukemia (AML) in first complete remission (CR1), who received a first HCT, from HLA-matched sibling donors (MSD), 10/10 HLA-matched unrelated donors (UD), 9/10 HLA-mismatched unrelated donors (mUD) or haploidentical (Haplo) donors. The 2-year overall survival (OS) was 48.1%, leukemia-free survival (LFS) 45.3%, relapse incidence (RI) 25.2%, non-relapse mortality (NRM) 29.5% and GVHD-free, relapse-free survival (GRFS), 33.4%. Compared to MSD, patients transplanted from Haplo and UD presented lower RI (HR 0.46, 95% CI 0.25-0.8, p = 0.02 and HR 0.44, 95% CI: 0.28-0.69, p = 0.001, respectively); this translated into prolonged LFS for Haplo (HR 0.62, 95% CI: 0.39-0.99, p = 0.04). Patients transplanted from mUD exhibited the highest NRM incidence (HR 2.33, 95% CI: 1.26-4.31, p = 0.007). HCT in selected adult CR1 AML patients >70 years is feasible and could be associated with good clinical outcomes. Prospective clinical trials are warranted.
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Affiliation(s)
- Enrico Maffini
- IRCCS Azienda Ospedaliero-Universitaria di Bologna; Istituto "L. e A. Seràgnoli", Bologna, Italy.
| | - Maud Ngoya
- EBMT ALWP Statistical Unit, Saint Antoine Hospital, Sorbonne University, Paris, France
| | | | - Samia Harbi
- Programme de Transplantation et Therapie Cellulaire, Centre de Recherche en Cancerologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | - Nicolaus Kröger
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uwe Platzbecker
- Medical Clinic and Policlinic 1, Hematology and Cellular Therapy, University hospital Leipzig, Leipzig, Germany
| | - Henrik Sengeloev
- Bone Marrow Transplant Unit L 4043, National University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Charles Craddock
- Birmingham Centre for Cellular Therapy and Transplantation, Birmingham, UK
| | - Victoria Potter
- Department of Haematological Medicine, Kings College Hospital, King's Denmark Hill Campus, London, UK
| | - Goda Choi
- University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Friedrich Stölzel
- University Hospital Dresden, Medizinische Klinik und Poliklinik I, Dresden, TU Dresden, Germany
| | - Eleni Tholouli
- Haematology Department, Manchester Royal Infirmary, Oxford Road, Manchester, UK
| | - Johan Maertens
- Department of Hematology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Fabio Ciceri
- Ospedale San Raffaele s.r.l., Haematology and BMT, Milano, Italy
| | - Jan Cornelissen
- Department of Haematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jaime Sanz
- Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Alexandros Spyridonidis
- Bone Marrow Transplantation Unit and Institute of Cellular therapy, University of Patras, Patras, Greece
| | - Francesco Lanza
- Hematology Unit, Ravenna Public Hospital and Romagna Transplant Network, Ravenna, Italy
| | - Arnon Nagler
- Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, Ramat-Gan, Israel
| | - Mohamad Mohty
- Clinical Hematology and Cellular Therapy Department, Sorbonne University, Saint Antoine Hospital, INSERM UMRs 938, Paris, France
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18
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Baron F, Ruggeri A, Peczynski C, Labopin M, Bourhis JH, Michallet M, Chevallier P, Sanz J, Forcade E, Saccardi R, Potter V, Gluckman E, Nagler A, Mohty M. Outcomes of graft failure after umbilical cord blood transplantation in acute leukemia: a study from Eurocord and the Acute Leukemia Working Party of the EBMT. Bone Marrow Transplant 2023; 58:936-941. [PMID: 37165084 DOI: 10.1038/s41409-023-02000-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 03/29/2023] [Accepted: 04/21/2023] [Indexed: 05/12/2023]
Abstract
Graft failure has remained a limitation of umbilical cord blood transplantation (CBT). Here, we assessed the outcomes of patients who experienced graft failure after CBT. Inclusion criteria were patients (age ≥ 18 years) experiencing graft failure after unrelated CBT (single or double) between 2005 and 2016, for acute myelogenous leukemia (AML) or acute lymphoblastic leukemia (ALL), no prior allogeneic or autologous transplantation, no other stem cell product. The study included 87 patients. At 1-year, cumulative incidence of relapse and nonrelapse mortality (NRM) was 35% and 37%, respectively. One-year overall survival (OS) and progression-free survival (PFS) was 40% and 29%, respectively. Forty-six patients underwent a salvage second transplantation with 1-year and 2-year OS and PFS from second transplantation 41% and 34% for OS, and 37% and 34% for PFS, respectively. In multivariate analysis, complete remission (CR) at CBT (HR = 0.45, 95% CI 0.25-0.83, P = 0.01) and reduced-intensity conditioning (HR = 0.51, 95% CI 0.29-0.91, P = 0.023) were associated with better OS. In conclusion, in this retrospective study, we observed that approximately one-quarter of patients experiencing graft failure after CBT remained alive without relapse 2 years later.
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Affiliation(s)
| | - Annalisa Ruggeri
- Eurocord, Saint Louis Hospital, Paris, France and Centre scientifique de Monaco, Paris, Monaco
- IRCCS San Raffaele Scientific Institute,department of Hematologogy and BMT, Milano, Italy
| | - Christophe Peczynski
- Department of Haematology, Saint Antoine Hospital, Paris, France
- EBMT Paris study office/CEREST-TC, Paris, France
- INSERM UMR 938, Paris, France
- Sorbonne university, Paris, France
| | - Myriam Labopin
- Department of Haematology, Saint Antoine Hospital, Paris, France
- EBMT Paris study office/CEREST-TC, Paris, France
- INSERM UMR 938, Paris, France
- Sorbonne university, Paris, France
| | - Jean-Henri Bourhis
- Gustave Roussy, institut de cancérologie, BMT Service, Division of Hematology, Villejuif, France
| | - Mauricette Michallet
- Service d'Hématologie du Centre de lutte contre le Cancer Léon Bérard, Lyon, France
| | | | - Jaime Sanz
- University Hospital La Fe, Hematology Department, Valencia, Spain
| | - Edouard Forcade
- Service d'Hématologie Clinique et Thérapie Cellulaire, CHU Bordeaux, F-33000, Bordeaux, France
| | - Riccardo Saccardi
- Azienda Ospedaliera Universitaria Careggi, Cell Therapy and Transfusion Medicine Unit, Firenze, Italy
| | | | - Eliane Gluckman
- Eurocord, Saint Louis Hospital, Paris, France and Centre scientifique de Monaco, Paris, Monaco
| | - Arnon Nagler
- 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
| | - Mohamad Mohty
- Department of Haematology, Saint Antoine Hospital, Paris, France
- EBMT Paris study office/CEREST-TC, Paris, France
- INSERM UMR 938, Paris, France
- Sorbonne university, Paris, France
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19
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Nagler A, Labopin M, Mielke S, Passweg J, Blaise D, Gedde-Dahl T, Cornelissen JJ, Salmenniemi U, Yakoub-Agha I, Reményi P, Socié G, van Gorkom G, Labussière-Wallet H, Huang XJ, Rubio MT, Byrne J, Craddock C, Griškevičius L, Ciceri F, Mohty M. Matched related versus unrelated versus haploidentical donors for allogeneic transplantation in AML patients achieving first complete remission after two induction courses: a study from the ALWP/EBMT. Bone Marrow Transplant 2023; 58:791-800. [PMID: 37045942 DOI: 10.1038/s41409-023-01980-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/14/2023]
Abstract
We compared transplants (HSCT) from matched related siblings (MSD) with those from matched 10/10 and mismatched 9/10 unrelated (UD) and T-replete haploidentical (Haplo) donors in acute myeloid leukemia (AML) in first complete remission (CR1) achieved after two inductions, a known poor prognostic factor. One thousand two hundred and ninety-five patients were included: MSD (n = 428), UD 10/10 (n = 554), UD 9/10 (n = 135), and Haplo (n = 178). Acute GVHD II-IV was higher in all groups compared to MSD. Extensive chronic (c) GVHD was significantly higher in UD 9/10 (HR = 2.52; 95% CI 1.55-4.11, p = 0.0002) and UD 10/10 (HR = 1.48; 95% CI 1.03-2.13, p = 0.036) and cGVHD all grades were higher in UD 9/10 vs MSD (HR = 1.77; 95% CI 1.26-2.49, p = 0.0009). Non-relapse mortality was higher in all groups compared to MSD. Relapse incidence, leukemia-free, and overall survival did not differ significantly between donor types. Finally, GVHD-free relapse-free survival was lower in HSCT from UD 9/10 (HR = 1.56, 95% CI 1.20-2.03, p = 0.0009) but not in those from UD 10/10 (HR = 1.13, p = 0.22) and Haplo donors (HR = 1.12, p = 0.43) compared to MSD. In conclusion, in AML patients undergoing HSCT in CR1 achieved after two induction courses 10/10 UD and Haplo but not 9/10 UD donors are comparable alternatives to MSD.
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Affiliation(s)
- Arnon Nagler
- Division of Hematology, Sheba Medical Center, Tel Hashomer, Israel.
| | - Myriam Labopin
- EBMT Paris Study Office, Department of Hematology, Saint Antoine Hospital, INSERM UMR 938, Sorbonne University, Paris, France
- Department of Hematology, Saint Antoine Hospital, INSERM UMR 938, Sorbonne University, Paris, France
| | - Stephan Mielke
- Department of Cell Therapy and Allogeneic Stem Cell Transplantation (CAST), Department of Laboratory Medicine (LabMED), Karolinska University Hospital and Institutet, Karolinska Comprehensive Cancer Center, Stockholm, Sweden
| | | | - Didier Blaise
- Programme de Transplantation & Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | - Tobias Gedde-Dahl
- Clinic for Cancer Medicine, Hematology Department, Section for Stem Cell Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Jan J Cornelissen
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Urpu Salmenniemi
- HUCH Comprehensive Cancer Center, Stem Cell Transplantation Unit, Helsinki, Finland
| | | | - Péter Reményi
- Department of Hematology and Stem Cell Transplant, Dél-pesti Centrumkórház - Országos Hematológiai és Infektológiai Intézet, Budapest, Hungary
| | - Gerard Socié
- Department of Hematology - BMT, Hôpital St. Louis, Paris, France
| | - Gwendolyn van Gorkom
- Department of Internal Medicine, Division of Hematology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Xiao-Jun Huang
- Peking University People's Hospital, Institute of Haematology, Xicheng District, Beijing, China
| | | | - Jenny Byrne
- Nottingham University Hospital, Nottingham, UK
| | - Charles Craddock
- Department of Haematology, University Hospital Birmingham NHS Trust, Queen Elizabeth Medical Centre, Edgbaston, Birmingham, UK
| | - Laimonas Griškevičius
- Vilnius University Hospital Santaros Klinikos, Haematology, Oncology & Transfusion Center, Vilnius, Lithuania
| | - Fabio Ciceri
- Hematology & Bone Marrow Transplant, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mohamad Mohty
- EBMT Paris Study Office, Department of Hematology, Saint Antoine Hospital, INSERM UMR 938, Sorbonne University, Paris, France
- Department of Hematology, Saint Antoine Hospital, INSERM UMR 938, Sorbonne University, Paris, France
- Department of Hematology, Hospital Saint Antoine, EBMT Paris Study Office/CEREST-TC, Saint Antoine Hospital, Paris, France
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20
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Nagler A, Labopin M, Blaise D, Raiola AM, Corral LL, Bramanti S, Sica S, Kwon M, Koc Y, Pavlu J, Kulagin A, Busca A, Rodríguez AB, Reményi P, Schmid C, Brissot E, Sanz J, Bazarbachi A, Giebel S, Ciceri F, Mohty M. Non-T-depleted haploidentical transplantation with post-transplant cyclophosphamide in patients with secondary versus de novo AML in first complete remission: a study from the ALWP/EBMT. J Hematol Oncol 2023; 16:58. [PMID: 37248463 PMCID: PMC10226209 DOI: 10.1186/s13045-023-01450-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/10/2023] [Indexed: 05/31/2023] Open
Abstract
We compared outcomes of adult patients with secondary acute myeloid leukemia (sAML) versus de novo AML after non-T-depleted haploidentical stem cell transplant (HaploSCT) with post-transplant cyclophosphamide (PTCy). Seventeen hundred and eleven AML patients (sAML-231, de novo-1480) in first complete remission transplanted from 2010 to 2021, were included. Patients with de novo AML were younger, median age 55.8 versus 60.8 years, p < 0.0001, had better transplantation comorbidity index (HCT-CI) ≥ 3 21.3% versus 40.8%, p < 0.0001 and Karnofsky performance status (KPS) with KPS ≥ 90 in 78% versus 68.5%, respectively, p = 0.002. The two patient groups did not differ with respect to gender, cytomegalovirus serostatus, and cell source. Median time from diagnosis to HaploSCT was 5.2 versus 4.9 months, respectively, p = 0.005. Fewer sAML patients received myeloablative conditioning 35.1% versus 50.1%, p < 0.0001. Two hundred and eleven sAML and 410 de novo AML patients were included in the matched-pair analysis matching two de novo AML with each sAML. No significant difference was observed in any transplantation outcome parameter between the sAML versus de novo AML groups. Two-year non-relapse mortality and relapse incidence did not differ with HaploSCT for de novo versus sAML; 21.4% versus 21%, hazard ratio (HR) = 0.98, p = 0.9 and 23.4% versus 20.6%, HR = 0.92, p = 0.67, respectively. Two-year leukemia-free survival, overall survival, and graft-versus-host disease (GVHD)-free, relapse-free survival were also not different between the de novo AML and sAML groups 55.2% versus 58.4%, HR = 0.95, p = 0.67; 61.4% versus 66.4%, HR = 0.91, p = 0.51 and 46.3% versus 48.2%, HR = 0.92, p = 0.48, respectively. Similarly, the incidence of engraftment as well as acute and chronic GVHD was similar between the 2 cohorts. In conclusion, HaploSCT with PTCy may be able to overcome the bad prognosis of sAML as results are not significantly different to those of HaploSCT in de novo AML.
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Affiliation(s)
- Arnon Nagler
- Division of Hematology, Sheba Medical Center, Tel Hashomer, Israel.
| | - Myriam Labopin
- EBMT Paris Study Office, Department of Haematology, Saint Antoine Hospital; INSERM UMR 938, Sorbonne University, Paris, France
- Department of Haematology, Saint Antoine Hospital, INSERM UMR 938, Sorbonne University, Paris, France
| | - Didier Blaise
- Programme de Transplantation and Therapie Cellulaire Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | - Anna Maria Raiola
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Stefania Bramanti
- Transplantation Unit Department of Oncology and Haematology, Istituto Clinico Humanitas, Milan, Italy
| | - Simona Sica
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mi Kwon
- Hematology Hospital GU Gregorio Marañon, Instituto de Investigacion Sanitaria Gregorio Marañon, Medicina UCM, Madrid, Spain
| | - Yener Koc
- Bone Marrow Transplant Unit, Medicana International Hospital Istanbul, Istanbuls, Turkey
| | - Jiri Pavlu
- Department of Haematology, Hammersmith Hospital, Imperial College, London, UK
| | - Alexander Kulagin
- Raisa Gorbacheva Memorial, Research Institute for Paediatric Oncology, Hematology, and Transplantation, First State Pavlov Medical University of St. Petersburg, St. Petersburg, Russia
| | - Alessandro Busca
- SSD Trapianto di Cellule Staminali, AOU Citta' Della Salute e della Scienza, Turin, Italy
| | | | - Péter Reményi
- Dél-pesti Centrumkórház - Országos Hematológiai és Infektológiai Intézet, Department Hematology and Stem Cell Transplant, Budapest, Hungary
| | - Christoph Schmid
- Department of Hematology and Oncology, Augsburg University Hospital, Augsburg, Germany
| | - Eolia Brissot
- Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, AP-HP, Sorbonne University, and INSERM UMRs 938, Paris, France
| | - Jaime Sanz
- Hematology Department, Hospital Universitari Politècnic La Fe, Valencia, Spain
| | - Ali Bazarbachi
- Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Sebastian Giebel
- Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Fabio Ciceri
- Ospedale San Raffaele, Haematology and BMT, Milan, Italy
| | - Mohamad Mohty
- EBMT Paris Study Office, Department of Haematology, Saint Antoine Hospital; INSERM UMR 938, Sorbonne University, Paris, France
- Department of Haematology, Saint Antoine Hospital, INSERM UMR 938, Sorbonne University, Paris, France
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21
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Lima ACM, Getz J, do Amaral GB, Loth G, Funke VAM, Nabhan SK, Petterle RR, de Marco R, Gerbase-DeLima M, Pereira NF, Bonfim C, Pasquini R. Donor-specific HLA antibodies are associated with graft failure and delayed hematologic recovery after unrelated donor hematopoietic cell transplantation. Transplant Cell Ther 2023:S2666-6367(23)01298-8. [PMID: 37220839 DOI: 10.1016/j.jtct.2023.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Graft failure (GF) is one of the major concerns after allogeneic hematopoietic cell transplantation (allo-HCT) and remains a significant cause of morbidity and mortality. Although earlier reports have associated the presence of donor-specific HLA antibodies (DSAs) with increased risk of GF after unrelated donor allo-HCT, recent studies have failed to confirm this association. OBJECTIVE We sought to validate the presence of DSAs as a risk factor for GF and hematologic recovery in the unrelated donor allo-HCT setting. STUDY DESIGN We retrospectively evaluated 303 consecutive patients who underwent their first unrelated donor allo-HCT at our institution from January 2008 to December 2017. DSA evaluation was performed using 2 Single Antigen Beads (SAB) assays, DSA titration with 1:2, 1:8, and 1:32 dilutions, C1q-binding assay, and absorption/elution protocol to assess possible false-positive DSA reactivity. The primary endpoints were neutrophil and platelet recovery and GF, whereas the secondary endpoint was overall survival. Multivariable analyses were performed using Fine-Gray competing risks regression or Cox proportional hazards regression models. RESULTS The median patient age was 14 years (range, 0-61 years), 56.1% were male, and 52.5% were transplanted for nonmalignant diseases. Eleven patients (3.63%) were DSA-positive. Of them, 10 had preexisting DSAs, and one showed post-transplant de novo DSA. Nine patients had 1 DSA, 1 had 2 DSAs, and 1 had 3 DSAs, with a median MFI of 4334 (range, 588-20,456) and 3581 (range, 227-12,266) in LABScreen and LIFECODES SAB assays, respectively. Overall, 21 patients experienced GF. Of them, 12 had primary graft rejection, 8 had secondary graft rejection, and 1 had primary poor graft function. The cumulative incidences of GF at 28, 100, and 365 days were 4.0% (95% CI, 2.2%-6.6%), 6.6% (95% CI, 4.2%-9.8%), and 6.9% (95% CI, 4.4%-10.2%), respectively. In the multivariable analyses, DSA-positive patients had significantly delayed neutrophil (subdistribution hazard ratio [SHR] = 0.48; 95% CI, 0.29-0.81; P = .006) and platelet recovery (SHR = 0.51; 95% CI, 0.35-0.74; P = .0003) than patients without DSAs. In addition, only DSAs were significant predictors of primary GF at 28 days (SHR = 2.78; 95% CI, 1.65-4.68; P = .0001). The Fine-Gray regression also demonstrated that the presence of DSAs was strongly associated with a higher incidence of overall GF (SHR = 7.60; 95%CI, 2.61-22.14; P = .0002). DSA-positive patients with GF had significantly higher median MFI values than DSA-positive patients who achieved engraftment in LIFECODES SAB assay using neat serum (10,334 vs. 1250; P = .006) and in LABScreen SAB at 1:32 dilution (1627 vs. 61; P = .006). All 3 patients with C1q-positive DSAs failed to engraft. DSAs were not predictive of inferior survival (hazard ratio = 0.50; 95% CI, 0.20-1.26, P = .14). CONCLUSIONS Our results validate the presence of DSAs as a significant risk factor for GF and poor hematologic recovery after unrelated donor allo-HCT. Thus, careful pre-transplant DSA evaluation may optimize unrelated donor selection and improve allo-HCT outcomes.
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Affiliation(s)
- Alberto Cardoso Martins Lima
- Immunogenetics Laboratory - Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil; Immunogenetics Institute (IGEN), Associação Fundo de Incentivo à Pesquisa, São Paulo, SP, Brazil.
| | - Joselito Getz
- Immunogenetics Laboratory - Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil
| | - Geovana Borsato do Amaral
- Immunogenetics Laboratory - Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil
| | - Gisele Loth
- Bone Marrow Transplantation Unit - Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil; Instituto de Pesquisa Pelé Pequeno Príncipe, Hospital Pequeno Príncipe, Curitiba, PR, Brazil
| | - Vaneuza Araújo Moreira Funke
- Bone Marrow Transplantation Unit - Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil
| | - Samir Kanaan Nabhan
- Bone Marrow Transplantation Unit - Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil
| | | | - Renato de Marco
- Immunogenetics Institute (IGEN), Associação Fundo de Incentivo à Pesquisa, São Paulo, SP, Brazil
| | - Maria Gerbase-DeLima
- Immunogenetics Institute (IGEN), Associação Fundo de Incentivo à Pesquisa, São Paulo, SP, Brazil
| | - Noemi Farah Pereira
- Immunogenetics Laboratory - Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil
| | - Carmem Bonfim
- Bone Marrow Transplantation Unit - Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil; Instituto de Pesquisa Pelé Pequeno Príncipe, Hospital Pequeno Príncipe, Curitiba, PR, Brazil
| | - Ricardo Pasquini
- Bone Marrow Transplantation Unit - Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil
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22
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Giebel S, Labopin M, Schroeder T, Swoboda R, Maertens J, Bourhis JH, Grillo G, Salmenniemi U, Hilgendorf I, Kröger N, Poiré X, Cornelissen JJ, Arat M, Savani B, Spyridonidis A, Nagler A, Mohty M. Fludarabine versus cyclophospamide in combination with myeloablative total body irradiation as conditioning for patients with acute myeloid leukemia treated with allogeneic hematopoietic cell transplantation. A study from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Am J Hematol 2023; 98:580-587. [PMID: 36626592 DOI: 10.1002/ajh.26825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/13/2022] [Accepted: 12/21/2022] [Indexed: 01/12/2023]
Abstract
Total body irradiation (TBI) at a dose of 12 Gy combined with cyclophosphamide (CyTBI12Gy) is one of the standard myeloablative regimens for patients with acute myeloid leukemia (AML) treated with allogeneic hematopoietic cell transplantation (allo-HCT). In clinical practice, cyclophosphamide may be substituted with fludarabine (FluTBI12Gy) to reduce toxicity. We retrospectively compared outcomes of CyTBI12Gy with FluTBI12Gy for patients with AML treated in complete remission (CR) with allo-HCT from either a matched sibling or unrelated donor. Of 1684 adults who met inclusion criteria, 109 patients in each group were included in a matched-pair analysis. The cumulative incidence of relapse at 2 years was 25% in the FluTBI12Gy compared to 28% in the CyTBI12Gy group (p = .44) while non-relapse mortality (NRM) was 17% versus 19%, (p = .89) respectively. The rates of leukemia-free survival and overall survival were 65% versus 54% (p = .28) and 70% versus 60.5% (p = .17). Cumulative incidence of grade 2-4 acute graft-versus-host disease (GVHD) was significantly lower for FluTBI12Gy than CyTBI12Gy (16% vs. 34%, p = .005), while the incidences of grade 3-4 acute GVHD and chronic GVHD did not differ significantly. The probability of GVHD and relapse-free survival was 49% in the FluTBI12Gy and 41% in the CyTBI12Gy group (p = .17). We conclude that for patients with AML treated with allo-HCT in CR, cyclophosphamide may be substituted with fludarabine in a regimen based on TBI at a dose of 12 Gy without negative impact on the efficacy. FluTBI12Gy is associated with reduced risk of grade 2-4 acute GVHD and encouraging survival rates.
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Affiliation(s)
- Sebastian Giebel
- Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Myriam Labopin
- AP-HP, Hôpital Saint-Antoine, Sorbonne Université, INSERM UMR-S 938, CRSA, Service d'Hématologie Clinique et Thérapie Cellulaire, Paris, France
| | - Thomas Schroeder
- Dept. of Hematology and Stem Cell Transplantation, University Hospital, Essen, Germany
| | - Ryszard Swoboda
- Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Johan Maertens
- Dept. of Hematology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Jean Henri Bourhis
- Department of Hematology, Gustave Roussy Cancer Campus BMT Service, Villejuif, France
| | - Giovanni Grillo
- Hematology Department, Asst Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Urpu Salmenniemi
- Stem Cell Transplantation Unit, HUCH Comprehensive Cancer Center, Helsinki, Finland
| | - Inken Hilgendorf
- Klinik für Innere Medizin II, (Abt. Hämatologie und Onkologie), Universitaetsklinikum Jena, Jena, Germany
| | - Nicolaus Kröger
- Bone Marrow Transplantation Centre, University Hospital Eppendorf, Hamburg, Germany
| | - Xavier Poiré
- Dept. of Haematology, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - Jan J Cornelissen
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Mutlu Arat
- Istanbul Florence Nightingale Hospital, Istanbul, Turkey
| | - Bipin Savani
- Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Arnon Nagler
- Hematology Division, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Mohamad Mohty
- AP-HP, Hôpital Saint-Antoine, Sorbonne Université, INSERM UMR-S 938, CRSA, Service d'Hématologie Clinique et Thérapie Cellulaire, Paris, France
- Department of Hematology, Hospital Saint Antoine, Paris, France
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23
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Bug G, Labopin M, Niittyvuopio R, Stelljes M, Reinhardt HC, Hilgendorf I, Kröger N, Kaare A, Bethge W, Schäfer-Eckart K, Verbeek M, Mielke S, Carlson K, Bazarbachi A, Spyridonidis A, Savani BN, Nagler A, Mohty M. Fludarabine/TBI 8 Gy versus fludarabine/treosulfan conditioning in patients with AML in first complete remission: a study from the Acute Leukemia Working Party of the EBMT. Bone Marrow Transplant 2023:10.1038/s41409-023-01965-x. [DOI: 10.1038/s41409-023-01965-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 03/13/2023] [Accepted: 03/17/2023] [Indexed: 04/03/2023]
Abstract
AbstractThe optimal reduced intensity conditioning (RIC) regimen is a matter of debate. We retrospectively compared conditioning with fludarabine plus fractionated total body irradiation of 8 Gy (FluTBI) and fludarabine plus treosulfan 30, 36 or 42 g/m2 (FluTreo) in 754 patients with AML above the age of 40 years undergoing an allogeneic hematopoietic stem cell transplant (HSCT) in first complete remission (CR). After balancing patient characteristics by propensity score matching of 115 patients in each group, FluTBI was associated with a significantly lower probability of relapse compared to FluTreo (18.3% vs. 34.7%, p = 0.018) which was counteracted by a higher non-relapse mortality (NRM, 16.8% vs. 5.3%, p = 0.02). Thus, overall survival and graft-versus-host disease-free and relapse-free survival at 2 years were similar between groups (OS 66.9% vs. 67.8%, GRFS 50.3% vs. 45.6%). Univariate analysis by age group demonstrated a higher NRM exclusively in patients ≥55 years of age treated with FluTBI compared to FluTreo (27.6% vs. 5.8%, p = 0.02), while a similarly low NRM was observed in patients <55 years in both groups (6.0% vs. 4.7%, p = ns). We conclude that both conditioning regimens are effective and safe, but FluTBI may better be reserved for younger patients below the age of 55 years.
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24
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Swoboda R, Labopin M, Giebel S, Schroeder T, Kröger N, Arat M, Savani B, Spyridonidis A, Hamladji RM, Potter V, Berceanu A, Yakoub-Agha I, Rambaldi A, Ozdogu H, Sanz J, Nagler A, Mohty M. Total body irradiation plus fludarabine versus busulfan plus fludarabine as a myeloablative conditioning for adults with acute myeloid leukemia treated with allogeneic hematopoietic cell transplantation. A study on behalf of the Acute Leukemia Working Party of the EBMT. Bone Marrow Transplant 2023; 58:282-287. [PMID: 36460819 DOI: 10.1038/s41409-022-01882-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 11/16/2022] [Accepted: 11/18/2022] [Indexed: 12/03/2022]
Abstract
Cyclophosphamide is frequently substituted with fludarabine (Flu) in conditioning regimens before allogeneic hematopoietic cell transplantation (allo-HCT). We aimed to compare retrospectively, total body irradiation (12 Gy) plus Flu (FluTBI12) versus busulfan (Bu) plus Flu (FB4) as a myeloablative conditioning before allo-HCT in patients with acute myeloid leukemia (AML). Out of 3203 patients who met the inclusion criteria, 109 patients treated with FluTBI12 and 213 treated with FB4 were included in a final matched-pair analysis. In both groups, median patient age was 41 years, first or second complete remission (CR1/CR2) proportion was 78%/22%, allo-HCT from an unrelated donor was performed in 78% of patients. The probabilities of leukemia-free survival and overall survival at 2 years in FluTBI12 and FB4 groups were 65% vs. 60% (p = 0.64) and 70% vs. 72% (p = 0.87), respectively. The cumulative incidence of relapse was 19% vs. 29% (p = 0.11), while non-relapse mortality was 16% vs. 11%, respectively (p = 0.13). There were no statistical differences in both acute and chronic graft-versus-host disease (GVHD) incidence. The probability of GVHD-free, relapse-free survival (GRFS) was 49% for both groups. FluTBI12 and FB4 are comparable myeloablative regimens before allo-HCT in AML patients transplanted in CR1 and CR2.
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Affiliation(s)
- Ryszard Swoboda
- Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland.
| | - Myriam Labopin
- Sorbonne Université, INSERM UMR-S 938, CRSA, Service d'Hématologie et Thérapie Cellulaire, AP-HP, Hôpital Saint-Antoine, 75 012, Paris, France
| | - Sebastian Giebel
- Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Thomas Schroeder
- Deptartment of Hematology and Stem Cell Transplantation, University Hospital, Essen, Germany
| | - Nicolaus Kröger
- University Hospital Eppendorf, Bone Marrow Transplantation Centre, Hamburg, Germany
| | - Mutlu Arat
- Istanbul Florence Nightingale Hospital, Hematopoietic SCT Unit, Istanbul, Turkey
| | - Bipin Savani
- Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Rose-Marie Hamladji
- Centre Pierre et Marie Curie, Service Hématologie Greffe de Moëlle, Alger, Algeria
| | - Victoria Potter
- Department of Haematological Medicine, Kings College Hospital, King's Denmark Hill Campus, London, UK
| | - Ana Berceanu
- Hopital Jean Minjoz Service d'Hématologie, Besancon, France
| | | | - Alessandro Rambaldi
- Department of Oncology and Hematology, University of Milan and ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Hakan Ozdogu
- Haematology Division, BMT Unit, Haematology Research Laboratory, Training & Medical, Baskent University Hospital, Adana, Turkey
| | - Jaime Sanz
- Hematology Department, University Hospital La Fe, Valencia, Spain
| | - Arnon Nagler
- Hematology Division, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Mohamad Mohty
- Department of Hematology, Hospital Saint Antoine, Paris, France
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25
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Allogeneic stem cell transplantation for patients with acute myeloid leukemia (AML) in second complete remission (CR2) transplanted from unrelated donors with post-transplant cyclophosphamide (PTCy). A study on behalf of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Bone Marrow Transplant 2023; 58:552-557. [PMID: 36823454 DOI: 10.1038/s41409-023-01940-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/08/2023] [Accepted: 02/14/2023] [Indexed: 02/25/2023]
Abstract
Post-transplant cyclophosphamide (PTCy) is being increasingly used as graft-versus-host disease (GVHD) prophylaxis post allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with acute myeloid leukemia (AML) transplanted in first complete remission (CR1). However, results may differ in patients transplanted in CR2. We retrospectively evaluated transplant outcomes of adult AML patients transplanted between 2010-2019 from 9-10/10 human leukocyte antigen (HLA)-matched unrelated donor (UD) in CR2. In total, 127 patients were included (median age 45.5 years, 54% male). Median follow-up was 19.2 months. Conditioning was myeloablative (MAC) in 50.4% and the graft source was peripheral blood in 93.7% of the transplants. Incidence of acute (a)GVHD II-IV and III-IV was 26.2% and 9.2%. Two-year total and extensive chronic (c)GVHD were 34.3% and 13.8 %, respectively. Two-year non-relapse mortality (NRM), relapse incidence (RI), leukemia-free survival (LFS), overall survival (OS), and GVHD-free, relapse-free survival (GRFS) were 17.2%, 21.1%, 61.7, %, 65.2%, and 49.3%, respectively. Time from diagnosis to transplant (>18 months) was a favorable prognostic factor for RI, LFS, OS, and GRFS while favorable risk cytogenetics was a positive prognostic factor for OS. The patient's age was a poor prognostic factor for NRM and cGVHD. Finally, the female-to-male combination and reduced intensity conditioning (RIC) were poor and favorable prognostic factors for cGVHD, respectively. We conclude that PTCy is an effective method for GVHD prophylaxis in AML patients undergoing allo-HCT in CR2 from UD.
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26
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Giebel S, Labopin M, Socié G, Aljurf M, Salmenniemi U, Labussière-Wallet H, Srour M, Kröger N, Zahrani MA, Lioure B, Reményi P, Arat M, Bourhis JH, Helbig G, Tbakhi A, Forcade E, Huynh A, Brissot E, Spirydonidis A, Savani BN, Peric Z, Nagler A, Mohty M. Fludarabine or cyclophosphamide in combination with total body irradiation as myeloablative conditioning prior to allogeneic hematopoietic cell transplantation for acute lymphoblastic leukemia: an analysis by the Acute Leukemia Working Party of the EBMT. Bone Marrow Transplant 2023; 58:506-513. [PMID: 36725978 DOI: 10.1038/s41409-023-01917-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/06/2023] [Accepted: 01/11/2023] [Indexed: 02/03/2023]
Abstract
In this registry-based study we retrospectively compared outcomes of allogeneic hematopoietic cell transplantation (allo-HCT) for adult patients with acute lymphoblastic leukemia (ALL) following conditioning with total body irradiation (TBI) combined with either cyclophosphamide (Cy) or fludarabine (Flu). TBI 12 Gy + Cy was used in 2105 cases while TBI 12 Gy + Flu was administered to 150 patients in first or second complete remission. In a multivariate model adjusted for other prognostic factors, TBI/Cy conditioning was associated with a reduced risk of relapse (HR = 0.69, p = 0.049) and increased risk of grade 2-4 acute graft-versus-host disease (GVHD, HR = 1.57, p = 0.03) without significant effect on other transplantation outcomes. In a matched-pair analysis the use of TBI/Cy as compared to TBI/Flu was associated with a significantly reduced rate of relapse (18% vs. 30% at 2 years, p = 0.015) without significant effect on non-relapse mortality, GVHD and survival. We conclude that the use of myeloablative TBI/Cy as conditioning prior to allo-HCT for adult patients with ALL in complete remission is associated with lower risk of relapse rate compared to TBI/Flu and therefore should probably be considered a preferable regimen.
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Affiliation(s)
- Sebastian Giebel
- Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland.
| | - Myriam Labopin
- Sorbonne Université, INSERM UMR-S 938, CRSA, Service d'hématologie et Thérapie Cellulaire, AP-HP, Hôpital Saint-Antoine, Paris, France.,European Society for Blood and Marrow Transplantation Paris Study Office/CEREST-TC, Paris, France
| | - Gerard Socié
- Hématologie APHP Hôpital Saint Louis, INSERM U976, Université de Paris, Paris, France
| | - Mahmoud Aljurf
- Oncology (Section of Adult Haematolgy/BMT), King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Urpu Salmenniemi
- Stem Cell Transplantation Unit, HUCH Comprehensive Cancer Center, Helsinki, Finland
| | | | - Micha Srour
- CHU de Lille LIRIC, INSERM U995, Université de Lille, Lille, France
| | - Nicolaus Kröger
- University Hospital Eppendorf, Bone Marrow Transplantation Centre, Hamburg, Germany
| | | | | | - Péter Reményi
- Department of Haematology and Stem Cell Transplant, Dél-pesti Centrumkórház - Országos Hematológiai és Infektológiai Intézet, Budapest, Hungary
| | - Mutlu Arat
- Hematopoietic SCT Unit, Demiroglu Bilim University Istanbul Florence Nightingale Hospital, Istanbul, Turkey
| | - Jean Henri Bourhis
- Department of Hematology, Gustave Roussy Cancer Campus BMT Service, Villejuif, France
| | - Grzegorz Helbig
- Dept. of Haematology and BMT, Silesian Medical University, Katowice, Poland
| | - Abdelghani Tbakhi
- King Hussein Cancer Centre, Queen Rania Street - Aljubiha, Amman, Jordan
| | | | - Anne Huynh
- CHU - Institut Universitaire du Cancer Toulouse, Oncopole, I.U.C.T-O, Toulouse, France
| | - Eolia Brissot
- Sorbonne Université, INSERM UMR-S 938, CRSA, Service d'hématologie et Thérapie Cellulaire, AP-HP, Hôpital Saint-Antoine, Paris, France
| | | | - Bipin N Savani
- Department of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Zinaida Peric
- Department of Internal Medicine, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Arnon Nagler
- Hematology Division, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Mohamad Mohty
- Sorbonne Université, INSERM UMR-S 938, CRSA, Service d'hématologie et Thérapie Cellulaire, AP-HP, Hôpital Saint-Antoine, Paris, France.,European Society for Blood and Marrow Transplantation Paris Study Office/CEREST-TC, Paris, France
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27
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Reduced 8-Gray Compared to Standard 12-Gray Total Body Irradiation for Allogeneic Transplantation in First Remission Acute Lymphoblastic Leukemia: A Study of the Acute Leukemia Working Party of the EBMT. Hemasphere 2023; 7:e812. [PMID: 36698616 PMCID: PMC9831184 DOI: 10.1097/hs9.0000000000000812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/28/2022] [Indexed: 01/27/2023] Open
Abstract
In this registry-based study, we compared outcomes of allogeneic hematopoietic cell transplantation (allo-HCT) in adult patients with acute lymphoblastic leukemia (ALL) transplanted in first complete remission (CR-1), following conditioning with total body irradiation (TBI) at a standard 12-Gray or at a lower 8-Gray total dose. Patients received fludarabine (flu) as the sole chemotherapy complementing TBI. Eight-Gray TBI/flu was used in 494 patients and 12-Gray TBI/flu in 145 patients. Eighty-eight (23.1%) and 36 (29%) of the patients had Ph-negative B-ALL, 222 (58.3%) and 53 (42.7%) had Ph-positive B-ALL, 71 (18.6%) and 35 (28.2%) T-ALL, respectively (P = 0.008). Patients treated with 8-Gray were older than ones received 12-Gray (median 55.7 versus 40.3 years, P < 0.0001) and were more frequently administered in vivo T-cell depletion (71% versus 40%, P <0.0001). In a multivariate model adjusted for age, type of ALL, and other prognostic factors, leukemia-free survival (primary endpoint) as well as relapse, nonrelapse mortality, overall survival, and GVHD-free, relapse-free survival were not influenced by the TBI dose. These results were confirmed when we focused on patients <55 years of age (median 47 years). Patients with Ph-positive ALL or T-ALL had significantly better survival outcomes than ones with Ph-negative B-ALL, mainly due to significantly fewer relapses. We conclude that 8-Gray TBI is sufficient for adult patients with ALL transplanted in CR-1 with no additional benefit of augmenting the conditioning intensity to 12-Gray.
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28
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Reduced post-transplant cyclophosphamide doses in haploidentical hematopoietic cell transplantation for elderly patients with hematological malignancies. Bone Marrow Transplant 2022; 58:386-392. [PMID: 36585459 DOI: 10.1038/s41409-022-01908-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 12/31/2022]
Abstract
Although post-transplant cyclophosphamide (PT-Cy) is effective for graft-versus-host disease (GVHD) prophylaxis, it is associated with toxicities, which might be dose-dependent. We compared the outcomes with PT-Cy at 80 mg/kg to those with PT-Cy at 100 mg/kg in elderly patients undergoing haploidentical hematopoietic cell transplantation (HCT). Inclusion criteria included peripheral blood stem cells, hematological malignancy, and age>65 years (or age>60 years if cardiac event history). Thirty-eight patients received PT-Cy at 80 mg/kg and 55 100 mg/kg, divided in two doses. The cumulative incidences (CI) of acute grade II-IV, acute grade III-IV, and moderate/severe chronic GVHD were 32%, 16%, and 13% with PT-Cy at 80 mg/kg compared to 33%, 13%, and 16% with 100 mg/kg, respectively. In multivariable analysis, reducing PT-Cy dose had no significant impact on GVHD. Neutrophil and platelet engraftments were significantly improved, and CI of BK virus-associated hemorrhagic cystitis was reduced with 80 mg/kg of PT-Cy compared to 100 mg/kg. At 2 years, non-relapse mortality was 16% and 31%, progression-free survival 65% and 49%, overall survival 70% and 56%, and GVHD-free, relapse-free survival 52% and 36% with 80 mg/kg and 100 mg/kg, respectively. Reducing PT-Cy dose to 80 mg/kg is safe and associated with improved hematological recovery and lower CI of hemorrhagic cystitis in elderly patients undergoing haploidentical HCT.
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29
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Haploidentical Versus Matched Sibling Donor Hematopoietic Stem Cell Transplantation for Adult Patients With Relapsed/Refractory Acute Lymphoblastic Leukemia: A Study From the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Hemasphere 2022; 6:e790. [PMID: 36258924 PMCID: PMC9575736 DOI: 10.1097/hs9.0000000000000790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/05/2022] [Indexed: 11/30/2022] Open
Abstract
The results of haploidentical stem cell transplantation (haploHCT) for patients with acute lymphoblastic leukemia (ALL) transplanted in active disease remain largely unknown. We retrospectively analyzed adult patients with R/R ALL who underwent haploHCT or matched sibling donor (MSD-HCT) as a first transplantation between 2012 and 2020. The analysis comprised 274 patients, 94 had a haploHCT, and 180 had an MSD-HCT. The median follow-up was 32 months. The median age was 33 (range 18-76) and 37 (18-76) years in the haplo- and MSD-HCT groups, respectively. Post-transplant cyclophosphamide (PTCy) was used in 88% of haploHCT and in 4% of the MSD-HCT group. Graft-versus-host disease grade III-IV was higher in haploHCT than in the MSD-HCT group (18% versus 9%; P = 0.042). The 2-year chronic (c) graft-versus-host disease rates were 17% versus 33% (hazard ratio [HR] = 0.56; P = 0.14), respectively. By multivariate analysis, relapse incidence, and leukemia-free survival were not significatively different between the transplant groups, while nonrelapse mortality (NRM) was significantly higher (25% versus 18% at 2 years; HR = 2.03; P = 0.042) and overall survival (OS) lower (22% versus 38% at 2 years; HR = 1.72; P = 0.009) in the haploHCT group compared with the MSD-HCT group. We conclude that the 2-year OS of R/R ALL patients undergoing MSD transplants is significantly better than in haploHCT with a higher NRM in the latter.
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30
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Trends in outcome of transplantation in patients with secondary acute myeloid leukemia: an analysis from the Acute Leukemia Working Party (ALWP) of the EBMT. Bone Marrow Transplant 2022; 57:1788-1796. [DOI: 10.1038/s41409-022-01825-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/31/2022] [Accepted: 09/05/2022] [Indexed: 11/08/2022]
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31
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Nagler A, Labopin M, Arat M, Reményi P, Koc Y, Blaise D, Angelucci E, Vydra J, Kulagin A, Socié G, Rovira M, Sica S, Aljurf M, Gülbas Z, Kröger N, Brissot E, Peric Z, Giebel S, Ciceri F, Mohty M. Posttransplant cyclophosphamide‐based anti–graft‐vs‐host disease prophylaxis in patients with acute lymphoblastic leukemia treated in complete remission with allogeneic hematopoietic cell transplantation from human leukocyte antigen‐mismatched unrelated donors versus haploidentical donors: A study on behalf of the
ALWP
of the
EBMT. Cancer 2022; 128:3959-3968. [DOI: 10.1002/cncr.34452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/06/2022] [Accepted: 07/20/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Arnon Nagler
- Hematology Division Chaim Sheba Medical Center Tel‐Hashomer Israel
| | - Myriam Labopin
- Sorbonne Université INSERM UMR‐S 938, CRSA, Service d'hématologie et Thérapie Cellulaire, AP‐HP, Hôpital Saint‐Antoine Paris France
- European Society for Blood and Marrow Transplantation Paris Study Office/CEREST‐TC Paris France
| | - Mutlu Arat
- Istanbul Florence Nightingale Hospital HSCT Unit Istanbul Turkey
| | - Péter Reményi
- Dél‐pesti Centrumkórház‐Országos Hematológiaiés Infektológiai Intézet Department of Haematology and Stem Cell Transplant Budapest Hungary
| | - Yener Koc
- Medicana International Hospital Istanbul Bone MarrowTransplant Unit Istanbul Turkey
| | - Didier Blaise
- Programme de Transplantation and Therapie Cellulaire Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes Marseille France
| | | | - Jan Vydra
- Institute of Hematology and Blood Transfusion Servicio de Hematología Prague Czech Republic
| | - Aleksandr Kulagin
- First State Pavlov Medical University of St. Petersburg Raisa Gorbacheva Memorial Research Institute for Pediatric Oncology, Hematology and Transplantation St. Petersburg Russia
| | - Gerard Socié
- Hopital St. Louis, Department of Hematology‐BMT Paris France
| | - Montserrat Rovira
- Hospital Clinic, Department of Hematology Institute of Hematology and Oncology Barcelona Spain
| | - Simona Sica
- Universita Cattolica S. Cuore, Istituto di Ematologia Ematologia Rome Italy
| | - Mahmoud Aljurf
- King Faisal Specialist Hospital and Research Centre Oncology (Section of Adult Haematolgy/BMT) Riyadh Saudi Arabia
| | - Zafer Gülbas
- Anadolu Medical Center Hospital Bone Marrow Transplantation Department Kocaeli Turkey
| | - Nicolaus Kröger
- University Hospital Eppendorf Bone Marrow Transplantation Centre Hamburg Germany
| | - Eolia Brissot
- Sorbonne Université INSERM UMR‐S 938, CRSA, Service d'hématologie et Thérapie Cellulaire, AP‐HP, Hôpital Saint‐Antoine Paris France
- European Society for Blood and Marrow Transplantation Paris Study Office/CEREST‐TC Paris France
| | - Zinaida Peric
- University of Zagreb School of Medicine Zagreb Croatia
| | - Sebastian Giebel
- Maria Sklodowska‐Curie National Research Institute of Oncology Gliwice Poland
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplant, IRCCS San Raffaele Scientific Institute Milan Italy
| | - Mohamad Mohty
- Department of Clinical Hematology and Cellular Therapy Saint‐Antoine Hospital, AP‐HP, Sorbonne University Paris France
- Sorbonne University INSERM, Saint‐Antoine Research Centre Paris France
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32
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Spyridonidis A, Labopin M, Brissot E, Moiseev I, Cornelissen J, Choi G, Ciceri F, Vydra J, Reményi P, Rovira M, Meijer E, Labussière-Wallet H, Blaise D, van Gorkom G, Kröger N, Koc Y, Giebel S, Bazarbachi A, Savani B, Nagler A, Mohty M. Should anti-thymocyte globulin be added in post-transplant cyclophosphamide based matched unrelated donor peripheral blood stem cell transplantation for acute myeloid leukemia? A study on behalf of the Acute Leukemia Working Party of the EBMT. Bone Marrow Transplant 2022; 57:1774-1780. [PMID: 36071114 DOI: 10.1038/s41409-022-01816-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 08/08/2022] [Accepted: 08/19/2022] [Indexed: 11/09/2022]
Abstract
In this registry-based study which includes acute myeloid leukemia patients who underwent a matched unrelated donor allogeneic peripheral-blood stem cell transplantation in complete remission and received post-transplant cyclophosphamide (PTCY) as graft-versus-host disease (GvHD) prophylaxis, we compared 421 recipients without anti-thymocyte globulin (ATG) with 151 patients with ATG. The only significant differences between PTCY and PTCY + ATG cohorts were the median year of transplant and the follow-up period (2017 vs 2015 and 19.6 vs 31.1 months, respectively, p < 0.0001). Overall, 2-year survival was 69.9% vs 67.1% in PTCY and PTCY + ATG, respectively, with deaths related to relapse (39% vs 43.5%), infection (21.9% vs 23.9%) or GvHD (17.1% vs 17.4%) not differing between groups. On univariate comparison, a significantly lower rate of extensive chronic GvHD was found when ATG was added (9.9% vs 21%, p = 0.029), a finding which was not confirmed in the multivariate analysis. The Cox-model showed no difference between PTCY + ATG and PTCY alone with respect to acute and chronic GvHD of all grades, non-relapse mortality, relapse, leukemia-free survival, overall survival, and GvHD-free-relapse-free survival between study cohorts. Our results highlight that the addition of ATG in PTCY does not provide any extra benefit in terms of further GvHD reduction, better GRFS or better survival.
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Affiliation(s)
- Alexandros Spyridonidis
- Bone Marrow Transplantation Unit and Institute of Cellular Therapy, University of Patras, Patras, Greece.
| | - Myriam Labopin
- EBMT Statistical Unit, Sorbonne Université, Hospital Saint-Antoine, Paris, France
| | - Eolia Brissot
- Department of Hematology, Hospital Saint Antoine, Paris, France
| | - Ivan Moiseev
- Gorbacheva Research Institute, Pavlov Univ., St Petersburg, Russian Federation
| | - Jan Cornelissen
- Erasmus MC Cancer Institute, University Medical Center, Rotterdam, Netherlands
| | - Goda Choi
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Fabio Ciceri
- Ospedale San Raffaele s.r.l., Haematology and BMT, Milano, Italy
| | - Jan Vydra
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | | | - Montserrat Rovira
- Hospital Clinic, Institute of Hematology & Oncology, Barcelona, Spain
| | - Ellen Meijer
- VU University Medical Center, Amsterdam, Netherlands
| | | | - Didier Blaise
- Programme de Transplantation & Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Marseille, France
| | | | - Nicolaus Kröger
- University Hospital Eppendorf, Bone Marrow Transplant Centre, Hamburg, Germany
| | - Yener Koc
- Bone Marrow Transplant Unit, Medicana International Hospital, Istanbul, Turkey
| | - Sebastian Giebel
- Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland
| | - Ali Bazarbachi
- Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Bipin Savani
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Arnon Nagler
- Hematology Division, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Mohamad Mohty
- Department of Hematology, Hospital Saint Antoine, Paris, France
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33
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Baron F, Labopin M, Tischer J, Ciceri F, Raiola AM, Blaise D, Sica S, Vydra J, Fanin R, Diez-Martin JL, Bulabois CE, Stölzel F, Busca A, Jindra P, Koc Y, Chevallier P, Forcade E, Rösler W, Passweg J, Kulagin A, Carella AM, Simand C, Bazarbachi A, Pioltelli P, Nagler A, Mohty M. Comparison of HLA-mismatched unrelated donor transplantation with post-transplant cyclophosphamide versus HLA-haploidentical transplantation in patients with active acute myeloid leukemia. Bone Marrow Transplant 2022; 57:1657-1663. [PMID: 35978005 DOI: 10.1038/s41409-022-01781-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 11/09/2022]
Abstract
HLA-haploidentical allogeneic hematopoietic stem cell transplantation (Haplo-HCT) is frequently used as treatment for patients with active acute myeloid leukemia (AML). Here, we investigated whether 9/10 HLA-mismatched unrelated donor transplantation (MMUD-HCT) with post-transplant cyclophosphamide (PTCy) is an adequate alternative. Inclusion criteria in this retrospective registry study consisted of adult patients, first HCT with a Haplo donor or MMUD between 2010 and 2020 using PTCy as graft-versus-host disease (GVHD) prophylaxis, and primary refractory or relapsed disease. MMUD patients were pair-matched 1 to 2 with Haplo-recipients. A total of 73 MMUD patients met the inclusion criteria. Their data were compared to those of 146 Haplo patients in a matched-pair analysis. Median follow-up was 27 months in MMUD patients and 36 months in Haplo recipients. Two-year incidences of relapse and non-relapse mortality (NRM) were 40% and 18% in MMUD patients, respectively, versus 50% (P = 0.23) and 24% (P = 0.18) in Haplo recipients. Two-year leukemia-free survival (LFS) and overall survival (OS) was 42% and 46% in MMUD recipients, respectively, versus 26% (P = 0.1) and 28% (P = 0.061) in Haplo-patients. In conclusions, in AML patients with active disease at transplantation, MMUD-HCT results in at least comparable outcomes to Haplo-HCT when PTCy is applied.
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Affiliation(s)
- Frédéric Baron
- Laboratory of Hematology, GIGA-I3, University of Liege and CHU of Liège, Liege, Belgium.
| | - Myriam Labopin
- EBMT Paris Study Office/CEREST-TC, Paris, France.,Service d'Hématologie Clinique, Hôpital Saint-Antoine, AP-HP, Paris, France.,INSERM UMRs 938, Paris, France.,Sorbonne University, Paris, France
| | - Johanna Tischer
- University Hospital of Munich - Campus Grosshadern, LMU, Department of Internal Medicine III, München, Germany
| | - Fabio Ciceri
- IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | | | - Didier Blaise
- Programme de Transplantation &Therapie Cellulaire, Département d'hématologie Centre de Recherche en Cancérologie de Marseille, Aix-Marseille University, Institut Paoli Calmettes, Marseille, France
| | - Simona Sica
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Jan Vydra
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Renato Fanin
- Division of Hematology, University Hospital and DAME, Udine, Italy
| | - Jose Luis Diez-Martin
- Head of Hematology Department, Hospital G U Gregorio Marañon, Instituto de Investigación Sanitaria Gregorio Marañon, Medicine Dpt. UCM, Madrid, Spain
| | - Claude Eric Bulabois
- CHU Grenoble Alpes - Université Grenoble Alpes, Service d'Hématologie, CS, 10217, Grenoble, France
| | - Friedrich Stölzel
- Universitätsklinikum Carl Gustav Carus Dresden, Medizinische Klinik und Poliklinik I, TU Dresden, Dresden, Germany
| | - Alessandro Busca
- S.S.C.V.D Trapianto di Cellule Staminali A.O.U Citta della Salute e della Scienza di Torino, Torino, Italy
| | - Pavel Jindra
- Department of Hematology/Oncology, Charles University Hospital, Pilsen, Czech Republic
| | - Yener Koc
- Medicana International Hospital Istanbul, Bone Marrow Transplant Unit, Istanbul, Turkey
| | | | - Edouard Forcade
- Service d'Hématologie Clinique et Thérapie Cellulaire, CHU Bordeaux, F-33000, Bordeaux, France
| | - Wolf Rösler
- Department of Internal Medicine 5, University Hospital Erlangen, Erlangen, Germany
| | | | - Alexander Kulagin
- RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia
| | - Angelo Michele Carella
- Ematologia e Centro Trapianti CSE Dipartimento di Scienze Mediche Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | | | - Ali Bazarbachi
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Pietro Pioltelli
- Ospedale San Gerardo, Clinica Ematologica dell'Universita Milano-Biocca, Monza, Italy
| | - Arnon Nagler
- Division of Hematology and Bone Marrow Transplantation, The Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Mohamad Mohty
- EBMT Paris Study Office/CEREST-TC, Paris, France.,Service d'Hématologie Clinique, Hôpital Saint-Antoine, AP-HP, Paris, France.,INSERM UMRs 938, Paris, France.,Sorbonne University, Paris, France
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Nagler A, Labopin M, Dholaria B, Ciceri F, Fraccaroli A, Blaise D, Fanin R, Bruno B, Forcade E, Vydra J, Chevallier P, Bulabois CE, Jindra P, Bornhäuser M, Canaani J, Sanz J, Savani BN, Spyridonidis A, Giebel S, Brissot E, Bazarbachi A, Esteve J, Mohty M. Impact of Cytogenetic Risk on Outcomes of Non-T-Cell–Depleted Haploidentical Hematopoietic Cell Transplantation in Patients with Relapsed or Refractory Acute Myeloid Leukemia. Transplant Cell Ther 2022; 28:773.e1-773.e8. [DOI: 10.1016/j.jtct.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/14/2022] [Accepted: 08/15/2022] [Indexed: 10/15/2022]
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Loke J, Labopin M, Craddock C, Cornelissen JJ, Labussière‐Wallet H, Wagner‐Drouet EM, Van Gorkom G, Schaap NP, Kröger NM, Veelken JH, Rovira M, Menard AL, Bug G, Bazarbachi A, Giebel S, Brissot E, Nagler A, Esteve J, Mohty M. Additional cytogenetic features determine outcome in patients allografted for TP53 mutant acute myeloid leukemia. Cancer 2022; 128:2922-2931. [PMID: 35612815 PMCID: PMC9545190 DOI: 10.1002/cncr.34268] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/20/2022] [Accepted: 04/22/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The presence of TP53 mutations is associated with an unfavorable outcome in patients allografted for acute myeloid leukemia (AML), leading some to question the benefit of an allogeneic stem cell transplantation (allo-SCT) for this patient group, although this has not been studied in a large cohort. METHODS A total of 780 patients with AML in first complete remission, with either intermediate- or adverse-risk cytogenetics, whose TP53 mutation status was reported, were included in this study from the European Society for Blood and Marrow Transplantation. RESULTS Two-year overall survival (OS) was impaired in patients (n = 179) with evidence of a TP53 mutation at diagnosis (35.1%; 95% confidence interval [CI], 26.7-43.7) as compared to the cohort without (n = 601) (64%; 95% CI, 59.1-68.4; P = .001). In patients with mutant TP53 AML with no evidence of either chromosome 17p loss (17p-) and/or complex karyotype (CK) (n = 53, 29.6%), 2-year OS was 65.2% (95% CI, 48.4-77.6). This was not significantly different to patients without TP53 mutations. In patients with mutant TP53 AML with either 17p- and/or CK (n = 126, 70.4%), the OS was lower (24.6%; 95% CI, 16.2-34; P = .001). CONCLUSIONS In summary, the adverse prognostic effect of TP53 mutations in AML following an allo-SCT is not evident in patients with neither co-occurring 17p- and/or CK, and these data inform decisions regarding allo-SCT in patients with TP53 mutant AML.
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Affiliation(s)
- Justin Loke
- Cancer Research UK, Clinical Trials UnitUniversity of BirminghamBirminghamUK
- Birmingham Center for Cellular Therapy and TransplantationCentre for Clinical Haematology, Queen Elizabeth HospitalBirminghamUK
| | - Myriam Labopin
- Acute Leukemia Working Party, Paris Study OfficeEuropean Society for Blood and Marrow TransplantationParisFrance
- Haematology DepartmentAP‐HP, Saint Antoine HospitalParisFrance
- INSERM, Centre de Recherche Saint‐Antoine (CRSA)Sorbonne Universités, UPMC Univ Paris 06ParisFrance
| | - Charles Craddock
- Cancer Research UK, Clinical Trials UnitUniversity of BirminghamBirminghamUK
- Birmingham Center for Cellular Therapy and TransplantationCentre for Clinical Haematology, Queen Elizabeth HospitalBirminghamUK
| | - Jan J. Cornelissen
- Department of Hematology, Erasmus MC Cancer InstituteUniversity Medical Center RotterdamRotterdamThe Netherlands
| | | | - Eva Maria Wagner‐Drouet
- Department of Hematology, Oncology, and PneumologyUniversity Medical Center MainzMainzGermany
| | - Gwendolyn Van Gorkom
- Department Internal Medicine Hematology/OncologyUniversity Hospital MaastrichtMaastrichtThe Netherlands
| | | | - Nicolaus M. Kröger
- University Hospital EppendorfBone Marrow Transplantation CentreHamburgGermany
| | | | | | | | - Gesine Bug
- Department of MedicineGoethe University FrankfurtFrankfurt MainGermany
| | - Ali Bazarbachi
- Bone Marrow Transplantation Program, Department of Internal MedicineAmerican University of Beirut Medical CenterBeirutLebanon
- Department of Anatomy, Cell Biology and Physiological SciencesAmerican University of BeirutBeirutLebanon
| | - Sebastian Giebel
- Maria Sklodowsk‐Curie Memorial Cancer Centre and Institute of OncologyGliwicePoland
| | - Eolia Brissot
- Haematology DepartmentAP‐HP, Saint Antoine HospitalParisFrance
- INSERM, Centre de Recherche Saint‐Antoine (CRSA)Sorbonne Universités, UPMC Univ Paris 06ParisFrance
| | - Arnon Nagler
- Hematology Division, Chaim Sheba Medical Center, Tel HashomerRamat GanIsrael
| | - Jordi Esteve
- Hospital Clinic, Department of HematologyIDIBAPSBarcelonaSpain
| | - Mohamad Mohty
- Haematology DepartmentAP‐HP, Saint Antoine HospitalParisFrance
- INSERM, Centre de Recherche Saint‐Antoine (CRSA)Sorbonne Universités, UPMC Univ Paris 06ParisFrance
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Nagler A, Galimard J, Labopin M, Blaise D, Arcese W, Trisolini SM, Wu D, Pigneux A, Van Gorkom G, Rubio M, Gedde‐Dahl T, Huynh A, Lanza F, Gorin N, Mohty M. Autologous stem cell transplantation (ASCT) for acute myeloid leukemia in patients in first complete remission after one versus two induction courses: A study from the ALWP of the EBMT. Cancer Med 2022; 12:1482-1491. [PMID: 35891608 PMCID: PMC9883552 DOI: 10.1002/cam4.5039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/19/2022] [Accepted: 07/07/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Achieving complete remission (CR) is the main goal in AML treatment and a prerequisite for successful autologous stem cell transplantation (ACT). METHODS Comparing results of peripheral blood ACT in patients with AML in CR1 attained following 1 versus 2 chemotherapy courses transplanted in 2000-2019. RESULTS Patients 1532 (84%) with one and 293 (16%) patients with two induction chemotherapies courses (a total of 1825 patients) were included in the study. Follow-up was 7.9 (95% CI: 7.4-8.4) and 7.7 (95% CI: 7.0-8.6) years (p = 0.8). Time from diagnosis to ACT was 4.7 (range, 3.9-5.8) versus 5.7 (range, 4.7-7.1) months (p < 0.001), respectively. Leukemia free survival (LFS) and overall survival (OS) at 5 years were inferior for patients achieving CR1 with 2 versus 1 course of chemotherapy: 26.6% versus 41.7% (HR = 1.42 [95% CI: 1.22-1.66], p < 0.001) and 36.2% versus 53.3%, (HR = 1.48 [95% CI: 1.25-1.75], p < 0.001), and 5-year relapse incidence (RI) was higher: 67.2% versus 52.3%, (HR = 1.46 [95% CI: 1.25-1.72], p < 0.001). Five-year non-relapse mortality (NRM) was 6.2% versus 6.0% for patients with 2 versus 1 chemotherapy courses, and did not differ significantly (HR = 1.31 [95% CI: 0.81-2.10], p = 0.27). CONCLUSIONS LFS and OS were inferior and relapse rate was higher in AML patients who received two inductions chemotherapy courses to reach CR1 before being autografted. AML patients who required 2 induction courses to achieve remission, may be offered allogeneic transplantation rather than an autologous one in an attempt to reduce their high RI and improve outcomes.
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Affiliation(s)
- Arnon Nagler
- Division of HematologySheba Medical CenterTel HashomerIsrael
| | | | - Myriam Labopin
- EBMT Statistical UnitParisFrance,Department of Clinical Hematology and Cellular Therapy, Saint‐Antoine Hospital, AP‐HPSorbonne UniversityParisFrance,Sorbonne University, INSERM, Saint‐Antoine Research CentreParisFrance
| | - Didier Blaise
- Programme de Transplantation & Therapie Cellulaire; Centre de Recherche en Cancérologie de MarseilleInstitut Paoli CalmettesMarseilleFrance
| | | | - Silvia Maria Trisolini
- Hematology, Department of Translational and Precision MedicineSapienza UniversityRomeItaly
| | - Depei Wu
- First Affiliated Hospital of Soochow University, Department of HematologySuzhouChina
| | - Arnaud Pigneux
- Service d'Hématologie et Thérapie Cellulaire, CHU BordeauxBordeauxFrance
| | - Gwendolyn Van Gorkom
- University Hospital Maastricht, Department of Internal Medicine Hematology/OncologyMaastrichtThe Netherlands
| | - Marie‐Thérèse Rubio
- Department of Hematology, Brabois HospitalCentre Hospitalier Régional Universitaire (CHRU)NancyFrance
| | - Tobias Gedde‐Dahl
- Department of Hematology, Institute of Clinical MedicineUniversity of Oslo and Oslo University Hospital‐RikshospitaletOsloNorway
| | - Anne Huynh
- Hematology DepartmentInstitut Universitaire du Cancer Toulouse‐OncopoleToulouseFrance
| | | | - Norbert‐Claude Gorin
- Department of Clinical Hematology and Cellular Therapy, Saint‐Antoine Hospital, AP‐HPSorbonne UniversityParisFrance,Sorbonne University, INSERM, Saint‐Antoine Research CentreParisFrance
| | - Mohamad Mohty
- Department of Clinical Hematology and Cellular Therapy, Saint‐Antoine Hospital, AP‐HPSorbonne UniversityParisFrance,Sorbonne University, INSERM, Saint‐Antoine Research CentreParisFrance
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Measurable residual disease (MRD) status before allogeneic hematopoietic cell transplantation impact on secondary acute myeloid leukemia outcome. A Study from the Acute Leukemia Working Party (ALWP) of the European society for Blood and Marrow Transplantation (EBMT). Bone Marrow Transplant 2022; 57:1556-1563. [PMID: 35835997 DOI: 10.1038/s41409-022-01748-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 06/14/2022] [Accepted: 06/27/2022] [Indexed: 12/21/2022]
Abstract
Measurable residual disease (MRD) assessment before allogeneic hematopoietic cell transplantation (HCT) may help physicians to identify a subgroup of patients at high risk of relapse for de novo acute myeloid leukemia (AML) but its relevance among patients affected by secondary AML (sAML) is still unknown. We assessed the impact of MRD among 318 adult patients with sAML who received an allogeneic HCT in first complete remission. At the time of HCT, a total of 208 (65%) patients achieved MRD negativity, while 110 (35%) had positive MRD. 2-year overall survival (OS) was 58.8 % (95% CI 52.2-64.9) with leukemia-free survival (LFS) of 50.0 % (95% CI 43.7-56.1), relapse incidence of 34.2% (95% CI 28.4-40.1) and non-relapse mortality (NRM) of 23.3 % (95% CI 19-27.7) for the entire cohort. In multivariate analysis, HCT recipients with KPS ≥ 90 experienced less disease recurrence (HR 0.61, 95% CI 0.4-0.94) with better LFS (HR 0.63, 95% CI 0.44-0.89) and OS (HR 0.58, 95% CI 0.39-0.86). There were no differences in major clinical endpoints between patients with MRD-positive and MRD-negative status at the time of HCT. Pre-transplantation assessment of MRD was not informative on post-HCT outcomes in this retrospective registry-based analysis among patients affected by sAML.
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Lima ACM, Bonfim C, Getz J, do Amaral GB, Petterle RR, Loth G, Nabhan SK, de Marco R, Gerbase-DeLima M, Pereira NF, Pasquini R. Untreated Donor-Specific HLA Antibodies Are Associated With Graft Failure and Poor Survival After Haploidentical Transplantation With Post-Transplantation Cyclophosphamide in Pediatric Patients With Nonmalignant Disorders. Transplant Cell Ther 2022; 28:698.e1-698.e11. [DOI: 10.1016/j.jtct.2022.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/10/2022] [Accepted: 07/18/2022] [Indexed: 10/16/2022]
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Immune reconstitution after allogenic stem cell transplantation: An observational study in pediatric patients. Hematol Transfus Cell Ther 2022:S2531-1379(22)00090-6. [DOI: 10.1016/j.htct.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/18/2022] [Accepted: 05/16/2022] [Indexed: 11/23/2022] Open
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40
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Outcome of human umbilical cord blood stem cell transplantation (CBT) for acute myeloid leukemia in patients achieving first complete remission after one versus two induction courses: a study from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT). Bone Marrow Transplant 2022; 57:1514-1519. [PMID: 35773347 DOI: 10.1038/s41409-022-01742-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 11/09/2022]
Abstract
We compared transplantation outcomes of adult patients with AML that underwent cord blood transplantation (CBT) in CR1 following 1 versus 2 induction courses. Study included 325 patients, 243 (75%) with 1 and 82 (25%) with 2 induction courses. Engraftment was lower for patients achieving CR1 after 1 vs. 2 induction courses: 91% vs. 99% (p = 0.02). Incidence of acute GVHD was similar, 38% and 36% (p = 0.81), as was 2-year chronic GVHD at 23.4% and 27.5%, respectively (p = 0.65). Two-year non-relapse mortality (NRM), relapse incidence (RI), leukemia-free survival (LFS), overall survival (OS) and GVHD-free, relapse-free survival (GRFS) were not statistically different between patients achieving CR1 with 1 vs. 2 induction courses with 23% vs. 24% (p = 0.87), 25% vs. 30% (p = 0.4), 52% vs. 46% (p = 0.3), 59% vs. 50% (p = 0.2), and 44% vs. 41% (p = 0.66), respectively. Results were confirmed by multivariable analysis, NRM (hazard ratio (HR) = 1.1; 95% CI, 0.6-1.8, p = 0.7), RI (HR = 1.4; 95% CI, 0.9-2.3, p = 0.1), LFS (HR = 1.3; 95% CI, 0.9-1.8, p = 0.2), OS (HR = 1.3; 95% CI, 0.9-1.9, p = 0.1), and GRFS (HR = 1.1; 95% CI, 0.8-1.5, p = 0.5). Overall, outcomes of AML patients undergoing CBT in CR1 achieved after 1 or 2 induction courses are similar.
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Reduced intensity versus non-myeloablative conditioning regimen for haploidentical transplantation and post-transplantation cyclophosphamide in complete remission acute myeloid leukemia: a study from the ALWP of the EBMT. Bone Marrow Transplant 2022; 57:1421-1427. [PMID: 35752739 DOI: 10.1038/s41409-022-01674-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 11/09/2022]
Abstract
The optimal conditioning regimen prior haploidentical stem cell transplantation (Haplo-SCT) with post transplantation cyclophosphamide (PT-Cy) for acute myeloid leukemia (AML) remains unknown. A non-myeloablative conditioning (NMAC) regimen (cyclophosphamide + fludarabine + TBI 2 Gy [CyFluTBI]) is a safe approach, but relapse incidence remains high in this setting. Alternatively, a reduced intensity conditioning (RIC) regimen combining thiotepa and reduced-dose busulfan with fludarabine (TBF) may decrease AML relapse. However, an excess of toxicity may counterbalance this potential benefit. We retrospectively compared CyFluTBI vs. TBF in CR AML patients who underwent Haplo-SCT with PT-Cy, in two different populations based on age. We analyzed 490 patients. In patients aged <60 years (n = 203), we observed a higher RI (HR = 3.59, 95% CI = 1.75-7.37, p < 0.01), lower LFS (HR = 1.98, 95% CI = 1.22-3.22, p < 0.01) and lower OS (HR = 1.73, 95% CI = 1.04-2.88, p = 0.04) in the CyFluTBI group, without significant difference in NRM. In older patients (n = 287), we observed that conditioning regimen did not significantly influence LFS (HR = 0.90, 95% CI = 0.56-1.44, p = 0.65), OS (HR = 0.81, 95% CI = 0.49-1.32, p = 0.39) and RI (HR = 1.78, 95% CI = 0.90-3.50, p = 0.10), but showed that CyFluTBI was associated with a significantly lower risk of NRM (HR = 0.48, 95% CI = 0.25-0.92, p = 0.03). Thus, younger patients seem to benefit from conditioning intensification from CyFluTBI to TBF regimens prior PT-Cy Haplo-SCT for CR AML, while older ones do not.
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Baron F, Labopin M, Tischer J, Ciceri F, Raiola AM, Blaise D, Sica S, Vydra J, Fanin R, Stölzel F, Busca A, Diez-Martin JL, Koc Y, Nagler A, Mohty M. HLA-haploidentical transplantation for relapsed/refractory AML: better LFS with BM than with PBSC in patients ≥ 55 years of age. Am J Hematol 2022; 97:1065-1074. [PMID: 35696192 DOI: 10.1002/ajh.26627] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/24/2022] [Accepted: 06/01/2022] [Indexed: 11/12/2022]
Abstract
The best stem cell source for T-cell replete HLA-haploidentical transplantation with post-transplant cyclophosphamide (PTCy) remains to be determined. In this EBMT retrospective study we analyzed the impact of stem cell source on leukemia-free survival (LFS) in adult patients with primary refractory or relapsed acute myeloid leukemia (AML) given grafts from HLA-haploidentical donors with PTCy as graft-versus-host disease (GVHD) prophylaxis. A total of 668 patients (249 bone marrow (BM) and 419 peripheral blood stem cells (PBSC) recipients) met the inclusion criteria. The use of PBSC was associated with a higher incidence of grade II-IV (HR = 1.59, P = 0.029) and grade III-IV (HR = 2.08, P = 0.013) acute GVHD. There was a statistical interaction between patient age and the impact of stem cell source for LFS (P < 0.01). In multivariate Cox models, among patients <55 years, the use of PBSC versus BM resulted in comparable LFS (HR = 0.82, P = 0.2). In contrast, in patients ≥55 years of age, the use of PBSC versus BM was associated with higher non-relapse mortality (NRM) (HR = 1.7, P = 0.01), lower LFS (HR = 1.37, P = 0.026) and lower overall survival (OS) (HR = 1.33, P = 0.044). In conclusions, our data suggest that in patients ≥55 years of age with active AML at HLA-haploidentical transplantation, the use of BM instead of PBSC as stem cell source results in lower NRM and better LFS. In contrast among younger patients, the use of PBSC results in at least a comparable LFS. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Frédéric Baron
- Laboratory of Hematology, GIGA-I3, University of Liege and CHU of Liège, Liege, Belgium
| | - Myriam Labopin
- EBMT Paris study office/CEREST-TC, Paris, France.,Department of Hematology, Saint Antoine Hospital, Paris, France.,INSERM UMR 938, Paris, France.,Université Pierre et Marie Curie, Paris, France
| | | | - Fabio Ciceri
- Ospedale San Raffaele s.r.l., Haematology and BMT, Milan, Italy
| | | | - Didier Blaise
- Programme de Transplantation&Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | - Simona Sica
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jan Vydra
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Renato Fanin
- Azienda Ospedaliero Universitaria di Udine, Division of Hematology, Udine, Italy
| | | | - Alessandro Busca
- SSCVD Trapianto di Cellule Staminali, AOU Citta della Salute e della Scienza di Torino, Torino, Italy
| | | | - Yener Koc
- Medicana International Hospital Istanbul, Bone Marrow Transplant Unit, Istanbul, Turkey
| | - Arnon Nagler
- Division of Hematology and Bone Marrow Transplantation, The Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Mohamad Mohty
- EBMT Paris study office/CEREST-TC, Paris, France.,Department of Hematology, Saint Antoine Hospital, Paris, France.,INSERM UMR 938, Paris, France.,Université Pierre et Marie Curie, Paris, France
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43
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Duque-Afonso J, Finke J, Labopin M, Craddock C, Protheroe R, Kottaridis P, Tholouli E, Byrne JL, Orchard K, Salmenniemi U, Hilgendorf I, Hunter H, Nicholson E, Bloor A, Snowden JA, Verbeek M, Clark A, Savani BN, Spyridonidis A, Nagler A, Mohty M. Comparison of fludarabine-melphalan and fludarabine-treosulfan as conditioning prior to allogeneic hematopoietic cell transplantation-a registry study on behalf of the EBMT Acute Leukemia Working Party. Bone Marrow Transplant 2022; 57:1269-1276. [PMID: 35568756 PMCID: PMC9352579 DOI: 10.1038/s41409-022-01646-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/04/2022] [Accepted: 03/15/2022] [Indexed: 11/09/2022]
Abstract
In recent years considerable variations in conditioning protocols for allogeneic hematopoietic cell transplantation (allo-HCT) protocols have been introduced for higher efficacy, lower toxicity, and better outcomes. To overcome the limitations of the classical definition of reduced intensity and myeloablative conditioning, a transplantation conditioning intensity (TCI) score had been developed. In this study, we compared outcome after two frequently used single alkylator-based conditioning protocols from the intermediate TCI score category, fludarabine/melphalan 140 mg/m2 (FluMel) and fludarabine/treosulfan 42 g/m2 (FluTreo) for patients with acute myeloid leukemia (AML) in complete remission (CR). This retrospective analysis from the registry of the Acute Leukemia Working Party (ALWP) of the European Society of Bone Marrow Transplantation (EBMT) database included 1427 adult patients (median age 58.2 years) receiving either Flu/Mel (n = 1005) or Flu/Treo (n = 422). Both groups showed similar 3-year overall survival (OS) (54% vs 51.2%, p value 0.49) for patients conditioned with FluMel and FluTreo, respectively. However, patients treated with FluMel showed a reduced 3-year relapse incidence (32.4% vs. 40.4%, p value < 0.001) and slightly increased non-relapse mortality (NRM) (25.7% vs. 20.2%, p value = 0.06) compared to patients treated with FluTreo. Our data may serve as a basis for further studies examining the role of additional agents/ intensifications in conditioning prior to allo-HCT.
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Affiliation(s)
- Jesus Duque-Afonso
- Department of Hematology/Oncology, Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany.
| | - Jürgen Finke
- Department of Hematology/Oncology, Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany
| | - Myriam Labopin
- EBMT Paris Study Office, Hopital Saint Antoine, Paris, France
| | - Charles Craddock
- Birmingham Centre for Cellular Therapy and Transplantation, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
| | - Rachel Protheroe
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - Eleni Tholouli
- Clinica Haematology Department, Manchester Royal Infirmary, Manchester, UK
| | - Jenny L Byrne
- Nottingham University, Hucknall Road, Nottingham, UK
| | - Kim Orchard
- Wessex Blood and Marrow Transplant and Cellular Therapy Program, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Urpu Salmenniemi
- Stem Cell Transplantation Unit, HUCH Comprehensive Cancer Center, Helsinki, Finland
| | - Inken Hilgendorf
- Universitaetsklinikum Jena, Klinik für Innere Medizin II, (Abt. Hämatologie und Onkologie), Am Klinikum 1, Jena, Germany
| | - Hannah Hunter
- University Hospitals Plymouth NHS Trust, Derriford Hospital, Plymouth, UK
| | - Emma Nicholson
- Department of Haematology, Royal Marsden Hospital, London, UK
| | - Adrian Bloor
- The Christie NHS Foundation Trust, Stem Cell Transplantation Unit, University of Manchester, Manchester, UK
| | - John A Snowden
- Sheffield Teaching Hospitals NHS Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Mareike Verbeek
- Klinikum Rechts der Isar, III Med Klinik der TU, Munich, Germany
| | - Andrew Clark
- Bone Marrow Transplant Unit, Beatson, West of Scotland Cancer Centre, Gartnaval General Hospital, Glasgow, UK
| | - Bipin N Savani
- Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Arnon Nagler
- Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Mohamad Mohty
- Sorbonne University, Saint-Antoine Hospital, AP-HP, INSERM UMRs 938, Paris, France.
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Impact of donor kinship on non-T-cell depleted haploidentical stem cell transplantation with post transplantation cyclophosphamide for acute leukemia: From the ALWP of the EBMT. Bone Marrow Transplant 2022; 57:1260-1268. [PMID: 35562547 DOI: 10.1038/s41409-022-01695-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 04/16/2022] [Accepted: 04/22/2022] [Indexed: 11/08/2022]
Abstract
Non-T-cell depleted haploidentical hematopoietic cell transplantation (Haplo-HCT) is a unique transplantation setting in which several donors are available. We assessed the impact of donor kinship on outcome of Haplo-HCT with post-transplantation cyclophosphamide in a cohort of 717 acute leukemia patients. We compared sibling with parent donors in patients ≤45 years, and child with sibling donors in patients >45 years. Donor kinship was not associated with worse outcomes in multivariate analysis. For patients ≤45 years, the hazard ratio (HR) for leukemia-free survival (LFS), overall survival (OS), relapse incidence (RI), and chronic graft-versus-host disease (cGVHD) was 0.87 (p = 0.75), 1.19 (p = 0.7), 0.52 (p = 0.19), and 0.99 (p = 0.97) for parents versus siblings, respectively, and for patients >45 years the HR was 0.93 (p = 0.8), 0.98 (p = 0.94), 1.3 (p = 0.53), and 0.98 (p = 0.95) for children versus siblings, respectively. Univariate incidence of acute GVHD grade II-IV was significantly higher in patients transplanted from siblings versus children (p = 0.002). Factors associated with inferior outcome were advanced disease and earlier transplant. In patients ≤45 years, acute lymphocytic leukemia and peripheral blood stem cell graft were additional prognostic factors for OS. We did not find a significant impact of donor kinship on transplantation outcome when analyzing by age group (≤45 and >45 years).
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Nagler A, Peczynski C, Dholaria B, Labopin M, Valerius T, Dreger P, Kröger N, Reinhardt HC, Finke J, Franke GN, Ciceri F, Verbeek M, Blau IW, Bornhäuser M, Spyridonidis A, Bug G, Bazarbachi A, Schmid C, Yakoub-Agha I, Savani BN, Mohty M. Impact of conditioning regimen intensity on outcomes of second allogeneic hematopoietic cell transplantation for secondary acute myelogenous leukemia. Bone Marrow Transplant 2022; 57:1116-1123. [PMID: 35501565 DOI: 10.1038/s41409-022-01693-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/19/2022] [Accepted: 04/21/2022] [Indexed: 11/09/2022]
Abstract
Limited data is available on factors impacting the outcomes of second hematopoietic cell transplantation (HCT2) in patients with secondary acute myeloid leukemia (sAML). This study aimed to assess HCT2 outcome for sAML comparing reduced-intensity (RIC) to myeloablative (MAC) conditioning. Two hundred and fifteen patients were included: RIC (n = 134), MAC (n = 81). The median follow-up was 41.1 (95% CI: 26.7-69.3) and 28.5 (95% CI: 23.9-75.4) months, respectively. At two years, the relapse incidence (RI) was 58.3% versus 51.1% in RIC and MAC, respectively. The 2-year leukemia free survival (LFS) was 26.6% versus 26%, and the graft-versus-host disease (GVHD)-free, relapse-free survival (GRFS) was 16.4% versus 12.1%, while OS was 31.4% and 39.7%, for RIC and MAC respectively. MVA showed a significantly lower RI [hazard ratio (HR) = 0.46 (95% CI, 0.26-0.8, p = 0.006)] and improved LFS [HR = 0.62 (95% CI, 0.39-0.98, p = 0.042)] with MAC versus RIC. The choice of conditioning regimen did not impact non-relapse mortality [HR = 1.14 (95% CI, 0.52-2.5, p = 0.74)], overall survival (OS) [HR = 0.72 (95% CI, 0.44-1.17, p = 0.18)] or GRFS [HR = 0.89 (95% CI, 0.59-1.36, p = 0.6)]. In conclusion, MAC was associated with a lower RI and superior LFS. These results support the use of MAC for eligible patients with sAML who are being considered for HCT2.
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Affiliation(s)
- Arnon Nagler
- Division of Hematology, Sheba Medical Center, Tel Hashomer, Israel
| | | | | | - Myriam Labopin
- Sorbonne University, Sevice d'hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, INSERM UMRs 938, Paris, France
| | - Thomas Valerius
- University Medical Center Schleswig Holstein, Campus Kiel, Section for Stem Cell Transplantation and Immunotherapy, Kiel, Germany
| | - Peter Dreger
- University of Heidelberg, Medizinische Klinik u. Poliklinik V, Heidelberg, Germany
| | - Nicolaus Kröger
- University Hospital Eppendorf, Bone Marrow Transplantation Centre, Hamburg, Germany
| | - Hans Christian Reinhardt
- University Duisburg-Essen, University Hospital Essen, Dept. of Bone Marrow Hematology and Stem Cell Transplantation, Essen, Germany
| | - Jürgen Finke
- University of Freiburg, Dept. of Medicine -Hematology, Oncology, Freiburg, Germany
| | - Georg-Nikolaus Franke
- Medical Clinic and Policinic 1, Hematology and Cellular Therapy, University Hospital Leipzig, Leipzig, Germany
| | - Fabio Ciceri
- Ospedale San Raffaele s.r.l., Haematology and BMT, Milano, Italy
| | - Mareike Verbeek
- Klinikum Rechts der Isar, III Med Klinik der TU, Munich, Germany
| | - Igor Wolfgang Blau
- Medizinische Klinik m. S. Hämatologie, Onkologie und Tumorimmunologie, Charité Universitätsmedizin, Berlin, Germany
| | - Martin Bornhäuser
- Universitaetsklinikum Dresden, Medizinische Klinik und Poliklinik I, Dresden, Germany
| | - Alexandros Spyridonidis
- Hematology Stem Cell Transplant Unit, School of Medicine, University of Patras, Patras, Greece
| | - Gesine Bug
- Department of Medicine 2, Hematology and Oncology, Goethe University Frankfurt, Frankfurt, Germany
| | - Ali Bazarbachi
- Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Christophe Schmid
- Department of Hematology and Oncology, University Hospital Augsburg, Augsburg, Germany
| | | | - Bipin N Savani
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mohamad Mohty
- Sorbonne University, Sevice d'hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, INSERM UMRs 938, Paris, France
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Outcomes of Different Haploidentical Transplantation Strategies from the Taiwan Blood and Marrow Transplantation Registry. Cancers (Basel) 2022; 14:cancers14041097. [PMID: 35205845 PMCID: PMC8870072 DOI: 10.3390/cancers14041097] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/08/2022] [Accepted: 02/19/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The two most noteworthy strategies for haploidentical stem cell transplantation (haplo-HSCT) are posttransplantation cyclophosphamide (PTCy) with or without thymoglobulin (ATG) and granulocyte colony stimulating factor-primed bone marrow plus peripheral blood stem cells (GIAC). We aimed to compare these approaches in patients with hematological malignancies. METHODS We enrolled 178 patients undergoing haplo-HSCT, including modified GIAC (mGIAC), PTCy without ATG, and PTCy with ATG. RESULTS The patients in the mGIAC group had the most favorable platelet and neutrophil engraftment kinetics. Although the grade III-IV acute graft-versus-host-disease (GvHD) rates were similar, those receiving mGIAC had a significantly higher extensive chronic GvHD rate. The patients receiving mGIAC had a similar cumulative incidence of relapse (CIR) to that in the patients receiving PTCy with ATG, but this was lower than that in the patients receiving PTCy without ATG. The patients receiving mGIAC had the lowest nonrelapse mortality (NRM) and the highest overall survival (OS) rates. The differences in CIR, NRM, and OS remained significant when focusing on patients with low/intermediate-risk diseases before haplo-HSCT. Intriguingly, among patients with high/very-high-risk diseases before haplo-HSCT, no differences were observed in the CIR, NRM, OS, or GvHD/relapse-free survival. CONCLUSION the mGIAC approach may yield a better outcome in Taiwanese patients with hematologic malignancies, especially for those with low/intermediate-risk diseases.
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Nagler A, Labopin M, Huang XJ, Blaise D, Arcese W, Araujo MC, Socié G, Forcade E, Ciceri F, Canaani J, Giebel S, Brissot E, Caballer JS, Bazarbachi A, Yakoub-Agha I, Mohty M. Non-T depleted haploidentical stem cell transplantation in AML patients achieving first complete remission after one versus two induction courses: a study from the ALWP/EBMT. Bone Marrow Transplant 2022; 57:572-578. [PMID: 35105964 DOI: 10.1038/s41409-021-01537-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 11/04/2021] [Accepted: 11/18/2021] [Indexed: 12/26/2022]
Abstract
There are no data indicating whether the number of induction courses needed to achieve first complete remission (CR1) is of prognostic significance in Haploidentical transplantation (HaploSCT). We compared transplantation outcomes of adults with AML that underwent HaploSCT in CR1, achieved following one or two induction courses. A total of 635 patients were included: 469 (74%) with 1 and 166 (26%) with two induction chemotherapy courses. A total of 429 (91.5%) and 151 (91%) patients had de novo AML and 40 (8.5%) and 15 (9%) had secondary AML (p = 0.84). Engraftment rates were 97.2 and 97.6%. Day 180 incidence of acute GVHD II-IV and III-IV was similar in both induction groups (31.1 and 34.8%, and 10 and 10.6 %), as was 2-4 year total and extensive chronic GVHD (33.7 and 36.5 %, and 12.2 and 12.1%), respectively. Two-year relapse incidence (RI) was higher while leukemia-free survival (LFS), overall survival (OS) and GVHD-free, relapse-free survival (GRFS) were inferior for patients achieving CR1 with 2 vs 1 course and were 29.1% vs 15.1%, 88 (p = 0.001), 56.2% vs 66.9% (p = 0.03), 58.8% vs 72.2% (p = 0.044) and 44% vs 55.6% (p = 0.013), respectively. Non-relapse mortality (NRM) did not differ, 18% vs 14.6% 90 (p = 0.25). These results were confirmed by multivariate analysis.
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Affiliation(s)
- Arnon Nagler
- Division of Hematology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel. .,ALWP of the EBMT Paris office, Paris, France.
| | - Myriam Labopin
- ALWP of the EBMT Paris office, Paris, France.,Sorbonne University, Department of Haematology, Saint Antoine Hospital; INSERM UMR 938, Paris, France
| | - Xiao-Jun Huang
- Institute of Hematology, Peking University People's Hospital, Beijing, China
| | - Didier Blaise
- Departement D'Hematologie, Programme de Transplantation et de Therapie Cellulaire, Centre de Recherche en Cancerologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | - William Arcese
- Rome Transplant Network, Università Tor Vergata, Roma, Italy
| | | | - Gerard Socié
- Assistance Publique-Hôpitaux de Paris, Hematology Stem Cell Transplantation, Saint Louis Hospital, Paris, France
| | | | - Fabio Ciceri
- Hematology and BMT Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Jonathan Canaani
- Hematology Division, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Sebastian Giebel
- Maria Sklodowska-Curie Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Eolia Brissot
- Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Sorbonne Université, INSERM UMRs 938, Paris, France
| | | | - Ali Bazarbachi
- Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ibrahim Yakoub-Agha
- Department of Haematology, Saint Antoine Hospital, INSERM UMR 938 and Sorbonne University, Paris, France
| | - Mohamad Mohty
- Sorbonne University, Department of Haematology, Saint Antoine Hospital; INSERM UMR 938, Paris, France
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Al Hamed R, Labopin M, Daguindau E, Niittyvuopio R, Huynh A, Socié G, Srour M, Henri Bourhis J, Kröger N, Tholouli E, Choi G, Poiré X, Martin H, Rubio MT, Jindra P, Blaise D, Beelen D, Labussière-Wallet H, Nagler A, Bazarbachi A, Mohty M. Measurable residual disease, FLT3-ITD mutation, and disease status have independent prognostic influence on outcome of allogeneic stem cell transplantation in NPM1-mutated acute myeloid leukemia. Cancer Med 2022; 11:1068-1080. [PMID: 35048553 PMCID: PMC8855908 DOI: 10.1002/cam4.4218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 07/24/2021] [Accepted: 08/02/2021] [Indexed: 11/12/2022] Open
Abstract
Nucleophosmin‐1 (NPM1) mutations in acute myeloid leukemia (AML) confer a survival advantage in the absence of FLT3‐internal tandem duplication (FLT3‐ITD). Here, we investigated the main predictors of outcome after allogeneic hematopoietic stem cell transplantation (allo‐HCT). We identified 1572 adult (age ≥ 18 year) patients with NPM1‐mutated AML in first complete remission (CR1:78%) or second complete remission (CR2:22%) who were transplanted from matched sibling donors (30.8%) or unrelated donors (57.4%) between 2007 and 2019 at EBMT participating centers. Median follow‐up for survivors was 23.7 months. FLT3‐ITD was present in 69.3% of patients and 39.2% had detectable minimal/measurable residual disease (MRD) at transplant. In multivariate analysis, relapse incidence (RI) and leukemia‐free survival (LFS) were negatively affected by concomitant FLT3‐ITD mutation (HR 1.66 p = 0.0001, and HR 1.53, p < 0.0001, respectively), MRD positivity at transplant (HR 2.18, p < 10−5 and HR 1.71, p < 10−5, respectively), and transplant in CR2 (HR 1.36, p = 0.026, and HR 1.26, p = 0.033, respectively), but positively affected by Karnofsky score ≥90 (HR 0.74, p = 0.012, and HR 0.7, p = 0.0002, respectively). Overall survival (OS) was also negatively influenced by concomitant FLT3‐ITD (HR 1.6, p = 0.0001), MRD positivity at transplant (HR 1.61, p < 10−5), and older age (HR 1.22 per 10 years, p < 0.0001), but positively affected by matched sibling donor (unrelated donor: HR 1.35, p = 0.012; haploidentical donor: HR 1.45, p = 0.037) and Karnofsky score ≥90 (HR 0.73, p = 0.004). These results highlight the independent and significant role of FLT3‐ITD, MRD status, and disease status on posttransplant outcomes in patients with NPM1‐mutated AML allowing physicians to identify patients at risk of relapse who may benefit from posttransplant prophylactic interventions.
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Affiliation(s)
- Rama Al Hamed
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Myriam Labopin
- Department of Hematology, EBMT Paris Office, CEREST-TC, Saint Antoine Hospital, Paris, France
| | | | - Riitta Niittyvuopio
- HUCH Comprehensive Cancer Center, Stem Cell Transplantation Unit, Helsinki, Finland
| | - Anne Huynh
- CHU - Institut Universitaire du Cancer Toulouse, Oncopole, Toulouse, France
| | - Gerard Socié
- Department of Hematology - BMT, Hôpital St. Louis, Paris, France
| | - Micha Srour
- CHU de Lille, Université de Lille, Lille, France
| | - Jean Henri Bourhis
- Department of Hematology, Gustave Roussy Cancer Campus, BMT Service, Villejuif, France
| | - Nicolaus Kröger
- University Hospital Eppendorf, Bone Marrow Transplantation Centre, Hamburg, Germany
| | - Eleni Tholouli
- Clinica Haematology Department, Manchester Royal Infirmary, Manchester, UK
| | - Goda Choi
- Department of Hematology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| | - Xavier Poiré
- Department of Haematology, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - Hans Martin
- Goethe-Universitaet, Medizinische Klinik II, Hämatologie, Medizinische Onkologie, Frankfurt, Germany
| | | | - Pavel Jindra
- Department of Hematology/Oncology, Charles University Hospital, Pilsen, Czech Republic
| | - Didier Blaise
- Programme de Transplantation & Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Marseille, France
| | - Dietrich Beelen
- Department of Bone Marrow Transplantation, University Hospital, Essen, Germany
| | | | - Arnon Nagler
- Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Ali Bazarbachi
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Mohamad Mohty
- Department of Hematology, EBMT Paris Office, CEREST-TC, Saint Antoine Hospital, Paris, France
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Total body irradiation plus fludarabine versus thiotepa, busulfan plus fludarabine as a myeloablative conditioning for adults with acute lymphoblastic leukemia treated with haploidentical hematopoietic cell transplantation. A study by the Acute Leukemia Working Party of the EBMT. Bone Marrow Transplant 2022; 57:399-406. [PMID: 35031709 DOI: 10.1038/s41409-021-01550-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 11/17/2021] [Accepted: 12/03/2021] [Indexed: 12/16/2022]
Abstract
Optimal conditioning for adults with acute lymphoblastic leukemia (ALL) treated with haploidentical hematopoietic cell transplantation (haplo-HCT) and post-transplant cyclophosphamide has not been established so far. We retrospectively compared outcomes for two myeloablative regimens: fludarabine + total body irradiation (Flu-TBI, n = 117) and thiotepa + iv. busulfan + fludarabine (TBF, n = 119). Patients transplanted either in complete remission (CR) or with active disease were included in the analysis. The characteristics of both groups were comparable except for patients treated with TBF were older. In univariate analysis the incidence of non-relapse mortality (NRM) at 2 years was increased for TBF compared to Flu-TBI (31% vs. 19.5%, p = 0.03). There was a tendency towards reduced incidence of relapse after TBF (p = 0.11). Results of multivariate analysis confirmed a reduced risk of NRM using Flu-TBI (HR = 0.49, p = 0.03). In the analysis restricted to patients treated in CR1 or CR2, the use of Flu-TBI was associated with a decreased risk of NRM (HR = 0.34, p = 0.009) but an increased risk of relapse (HR = 2.59, p = 0.01) without significant effect on survival and graft-versus-host disease. We conclude that for haplo-HCT recipients with ALL, Flu-TBI may be preferable for individuals at high risk of NRM while TBF should be considered in cases at high risk of relapse.
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50
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Nagler A, Labopin M, Dholaria B, Wu D, Choi G, Aljurf M, Ciceri F, Gedde-Dahl T, Meijer E, Niittyvuopio R, Bondarenko S, Bourhis JH, Cornelissen JJ, Socié G, Koc Y, Canaani J, Savani B, Bug G, Spyridonidis A, Giebel S, Brissot E, Bazarbachi A, Esteve J, Mohty M. Graft-versus-Host Disease Prophylaxis with Post-Transplantation Cyclophosphamide versus Cyclosporine A and Methotrexate in Matched Sibling Donor Transplantation. Transplant Cell Ther 2021; 28:86.e1-86.e8. [PMID: 34856420 DOI: 10.1016/j.jtct.2021.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/04/2021] [Indexed: 11/30/2022]
Abstract
Cyclosporine A (CSA) and methotrexate (MTX) is the standard graft-versus-host disease (GVHD) prophylaxis regimen for matched sibling donor (MSD) allogeneic hematopoietic cell transplantation (allo-HCT). Recently, post-transplantation cyclophosphamide (PTCy) has been shown to be effective in GVHD prevention. In this registry-based study, we compared outcomes of 118 patients treated with PTCy and 1202 patients with CSA/MTX who underwent MSD allo-HCT for acute myelogenous leukemia. In a matched-pair analysis, PTCy was associated with a higher incidence of relapse at 2 years compared with CSA/MTX (41.1% versus 21.3%; P = .039). The incidences of day +180 grade II-IV acute GVHD and 2-year chronic GVHD were comparable in the PTCy and CSA/MTX arms (25.2% versus 25.4% [P = .90] and 42.6% versus 42.6% [P = .84], respectively). Similarly, 2-year leukemia-free survival (LFS; 54.4% versus 74.32%; P = .052), overall survival (OS; 70.6% versus 79.7%; P = .15), and GVHD-free relapse-free survival (GRFS; 38.1% versus 52.5%; P = .49) were not statistically different in the 2 arms. Our data show that GVHD prophylaxis with PTCy is feasible, resulting in similar incidences of GVHD, GRFS, LFS, and OS as seen with conventional CSA/MTX in patients undergoing allo-HCT from an MSD. The higher rate of relapse observed with PTCy needs further evaluation in a prospective study. © 2021 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.
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Affiliation(s)
- Arnon Nagler
- Chaim Sheba Medical Center, Tel Hashomer, Israel and ALWP Office, Hôpital Saint-Antoine, Paris, France
| | - Myriam Labopin
- Department of Clinical Hematology and Cellular Therapy, Saint-Antoine Hospital, AP-HP, Sorbonne University, Paris, France; Sorbonne University, INSERM, Saint-Antoine Research Centre, Paris, France
| | - Bhagirathbhai Dholaria
- Department of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Depei Wu
- Department of Hematology, The First Hospital Affiliated to Soochow University, Suzhou, China
| | - Goda Choi
- Department of Hematology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| | - Mahmoud Aljurf
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | | | | | - Ellen Meijer
- Department of Hematology (Br 250), VU University Medical Center, Amsterdam, The Netherlands
| | - Riitta Niittyvuopio
- HUCH Comprehensive Cancer Center, Stem Cell Transplantation Unit, Helsinki, Finland
| | - Sergey Bondarenko
- RM Gorbacheva Research Institute, Pavlov University, Saint Petersburg, Russian Federation
| | | | - Jan J Cornelissen
- Erasmus MC-Daniel den Hoed Cancer Centre, Rotterdam, The Netherlands
| | | | - Yener Koc
- Medicana International Hospital, Istanbul, Turkey
| | | | - Bipin Savani
- Department of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gesine Bug
- Goethe University, Frankfurt am Main, Germany
| | | | - Sebastian Giebel
- Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Institute-Oncology Center, Gliwice Branch, Gliwice, Poland
| | - Eolia Brissot
- Department of Clinical Hematology and Cellular Therapy, Saint-Antoine Hospital, AP-HP, Sorbonne University, Paris, France; Sorbonne University, INSERM, Saint-Antoine Research Centre, Paris, France
| | - Ali Bazarbachi
- Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jordi Esteve
- Hematology Department, Hospital Clínic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Mohamad Mohty
- Department of Clinical Hematology and Cellular Therapy, Saint-Antoine Hospital, AP-HP, Sorbonne University, Paris, France; Sorbonne University, INSERM, Saint-Antoine Research Centre, Paris, France
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