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. 2020 May 6;13(1):46.
doi: 10.1186/s13045-020-00882-6.

Post-transplant Cyclophosphamide After Matched Sibling, Unrelated and Haploidentical Donor Transplants in Patients With Acute Myeloid Leukemia: A Comparative Study of the ALWP EBMT

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Free PMC article

Post-transplant Cyclophosphamide After Matched Sibling, Unrelated and Haploidentical Donor Transplants in Patients With Acute Myeloid Leukemia: A Comparative Study of the ALWP EBMT

Jaime Sanz et al. J Hematol Oncol. .
Free PMC article

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.

Keywords: Acute leukemia; Allogeneic stem cell transplant; Alternative donor transplants; Haploidentical transplant; Post-transplant cyclophosphamide.

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Cumulative incidence of relapse according to the type of transplant
Fig. 2
Fig. 2
Cumulative incidence of non-relapse mortality according to the type of transplant
Fig. 3
Fig. 3
Probability of leukemia-free survival according to the type of transplant
Fig. 4
Fig. 4
Probability of overall survival according to the type of transplant

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