1
|
Sanz J, Galimard JE, Labopin M, Afanasyev B, Sergeevich MI, Angelucci E, Kröger N, Koc Y, Ciceri F, Diez-Martin JL, Arat M, Sica S, Rovira M, Aljurf M, Tischer J, Savani B, Ruggeri A, Nagler A, Mohty M. Post-transplant cyclophosphamide containing regimens after matched sibling, matched unrelated and haploidentical donor transplants in patients with acute lymphoblastic leukemia in first complete remission, a comparative study of the ALWP of the EBMT. J Hematol Oncol 2021; 14:84. [PMID: 34049582 PMCID: PMC8161915 DOI: 10.1186/s13045-021-01094-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 05/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is no information on the impact of donor type in allogeneic hematopoietic stem cell transplantation (HCT) using homogeneous graft-versus-host (GVHD) prophylaxis with post-transplant cyclophosphamide (PTCy) in acute lymphoblastic leukemia (ALL). METHODS We retrospectively analyzed outcomes of adult patients with ALL in CR1 that had received HCT with PTCy as GVHD prophylaxis from HLA-matched sibling (MSD) (n = 78), matched unrelated (MUD) (n = 94) and haploidentical family (Haplo) (n = 297) donors registered in the EBMT database between 2010 and 2018. The median follow-up period of the entire cohort was 2.2 years. RESULTS Median age of patients was 38 years (range 18-76). Compared to MSD and MUD, Haplo patients received peripheral blood less frequently. For Haplo, MUD, and MSD, the cumulative incidence of 100-day acute GVHD grade II-IV and III-IV, and 2-year chronic and extensive chronic GVHD were 32%, 41%, and 34% (p = 0.4); 13%, 15%, and 15% (p = 0.8); 35%, 50%, and 42% (p = 0.01); and 11%, 17%, and 21% (p = 0.2), respectively. At 2 years, the cumulative incidence of relapse and non-relapse mortality was 20%, 20%, and 28% (p = 0.8); and 21%, 18%, and 21% (p = 0.8) for Haplo, MUD, and MSD, respectively. The leukemia-free survival, overall survival and GVHD-free, relapse-free survival for Haplo, MUD, and MSD was 59%, 62%, and 51% (p = 0.8); 66%, 69%, and 62% (p = 0.8); and 46%, 44%, and 35% (p = 0.9), respectively. On multivariable analysis, transplant outcomes did not differ significantly between donor types. TBI-based conditioning was associated with better LFS. CONCLUSIONS Donor type did not significantly affect transplant outcome in patient with ALL receiving SCT with PTCy.
Collapse
Affiliation(s)
- Jaime Sanz
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
- CIBERONC, Instituto Carlos III, Madrid, Spain.
| | - Jacques-Emmanuel Galimard
- EBMT Paris Study Office, 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
| | - Boris Afanasyev
- RM Gorbacheva Research Institute, Pavlov University, Lva Tolstogo 6/8, 197022, Saint-Petersburg, Russian Federation
| | - Moiseev Ivan Sergeevich
- RM Gorbacheva Research Institute, Pavlov University, Lva Tolstogo 6/8, 197022, Saint-Petersburg, Russian Federation
| | - Emanuele Angelucci
- Hematology and Transplant Center, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Nicolaus Kröger
- Bone Marrow Transplantation Centre, University Hospital Eppendorf, Hamburg, Germany
| | - Yener Koc
- Medicana International, Istanbul, Turkey
| | - Fabio Ciceri
- Ospedale San Raffaele s.r.l., Haematology and BMT, Milan, Italy
| | - J L Diez-Martin
- Hematology Department, Hospital GU Gregorio Marañon, Instituto de Investigación Sanitaria Gregorio Marañon, Universidad Complutense Madrid, Madrid, Spain
| | - Mutlu Arat
- Florence Nightingale Sisli Hospital, Hematopoietic SCT Unit, Istanbul, Turkey
| | - Simona Sica
- Istituto di Ematologia, Universita Cattolica S. Cuore, Rome, Italy
| | - Montserrat Rovira
- Department of Hematology, Hospital Clinic, Institute of Hematology and Oncology, Barcelona, Spain
- August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Mahmoud Aljurf
- King Faisal Specialist Hospital and Research Centre Oncology (Section of Adult Haematolgy/BMT), Riyadh, Saudi Arabia
| | - Johanna Tischer
- Department of Internal Medicine III, Grosshadern, LMU, University Hospital of Munich, Munich, Germany
| | - Bipin Savani
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Arnon Nagler
- Division of Hematology and Bone Marrow Transplantation, The Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Mohamad Mohty
- Department of Hematology, and INSERM UMRs 938, Hopital Saint Antoine, Sorbonne University, Paris, France
| |
Collapse
|
2
|
Sanz J, Galimard JE, Labopin M, Afanasyev B, Angelucci E, Ciceri F, Blaise D, Cornelissen JJ, Meijer E, Diez-Martin JL, Koc Y, Rovira M, Castagna L, Savani B, Ruggeri A, Nagler A, Mohty M. Post-transplant cyclophosphamide after matched sibling, unrelated and haploidentical donor transplants in patients with acute myeloid leukemia: a comparative study of the ALWP EBMT. J Hematol Oncol 2020; 13:46. [PMID: 32375860 PMCID: PMC7201995 DOI: 10.1186/s13045-020-00882-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 04/23/2020] [Indexed: 02/06/2023] Open
Abstract
Background The use of post-transplant cyclophosphamide (PTCy) is highly effective in preventing graft-versus-host disease (GVHD) in the haploidentical (Haplo) transplant setting and is being increasingly used in matched sibling (MSD) and matched unrelated (MUD) transplants. There is no information on the impact of donor types using homogeneous prophylaxis with PTCy. Methods We retrospectively compared outcomes of adult patients with acute myeloid leukemia (AML) in first complete remission (CR1) who received a first allogeneic stem cell transplantation (SCT) with PTCy as GVHD prophylaxis from MSD (n = 215), MUD (n = 235), and Haplo (n = 789) donors registered in the EBMT database between 2010 and 2017. Results The median follow-up was 2 years. Haplo-SCT carried a significantly increased risk of acute grade II–IV GVHD (HR 1.6; 95% CI 1.1–2.4) and NRM (HR 2.6; 95% CI 1.5–4.5) but a lower risk of relapse (HR 0.7; 95% CI 0.5–0.9) that translated to no differences in LFS (HR 1.1; 95% CI 0.8–1.4) or GVHD/relapse-free survival (HR 1; 95% CI 0.8–1.3). Interestingly, the use of peripheral blood was associated with an increased risk of acute (HR 1.9; 95% CI 1.4–2.6) and chronic GVHD (HR 1.7; 95% CI 1.2–2.4) but a lower risk of relapse (HR 0.7; 95% CI 0.5–0.9). Conclusions The use of PTCy in patients with AML in CR1 receiving SCT from MSD, MUD, and Haplo is safe and effective. Haplo-SCT had increased risk of acute GVHD and NRM and lower relapse incidence but no significant difference in survival.
Collapse
Affiliation(s)
- Jaime Sanz
- Hematology Department, Hospital Universitari i Politècnic La Fe, Avinguda Fernando Abril Martorell, 106, 46026, Valencia, Spain. .,CIBERONC, Instituto Carlos III, Madrid, Spain.
| | | | - Myriam Labopin
- EBMT Paris Office, Hospital Saint Antoine, Paris, France.,Department of Hematology, Hopital Saint Antoine, Sorbonne University, Paris, France
| | - Boris Afanasyev
- First State Pavlov Medical University of St. Petersburg, Raisa Gorbacheva Memorial Research Institute for Paediatric Oncology, Hematology, and Transplantation, St Petersburg, Russia
| | - Emanuele Angelucci
- Department of Haematology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Fabio Ciceri
- Haematology and BMT, Ospedale San Raffaele s.r.l., Milano, Italy
| | - Didier Blaise
- Programme de Transplantation & Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | - Jan J Cornelissen
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ellen Meijer
- Department of Hematology (Br 250), VU University Medical Center, Amsterdam, The Netherlands
| | - J L Diez-Martin
- Hematology Department, Hospital GU Gregorio Marañon, Instituto de Investigación sanitaria Gregorio Marañon, Universidad Complutense Madrid, Madrid, Spain
| | - Yener Koc
- Stem Cell Transplant Unit, Medical Park Hospitals, Antalya, Turkey
| | - Montserrat Rovira
- Dept. of Hematology, Institute of Hematology & Oncology, Hospital Clinic, Barcelona, Spain.,Institut d'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), Institut Josep Carreras, University of Barcelona, Barcelona, Spain
| | - Luca Castagna
- Transplantation Unit, Department of Oncology and Haematology, Istituto Clinico Humanitas, Milan, Italy
| | - Bipin Savani
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Annalisa Ruggeri
- Department of Pediatric Hematology and Oncology, IRCCS Bambino Gesù Children's Hospital, Piazza S.Onofrio, 4, Rome, Italy
| | - Arnon Nagler
- Division of Hematology and Bone Marrow Transplantation, The Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.,ALWP of the EBMT office, Saint Antoine Hospital, Paris, France
| | - Mohamad Mohty
- Department of Hematology, Hopital Saint Antoine, Sorbonne University, Paris, France
| | | |
Collapse
|