Comparing outcomes of a second allogeneic hematopoietic cell transplant using HLA-matched unrelated versus T-cell replete haploidentical donors in relapsed acute lymphoblastic leukemia: a study of the Acute Leukemia Working Party of EBMT.
Mohamed A Kharfan-DabajaMyriam LabopinAli BazarbachiFabio CiceriJürgen FinkeBenedetto BrunoMartin BornhäuserTobias Gedde-DahlHélène Labussière-WalletRiitta NiittyvuopioThomas ValeriusEmanuele AngelucciArne BrechtDolores CaballeroJürgen H E KuballVictoria PotterChristoph SchmidJohanna TischerTsila ZukermanFabio BenedettiDidier BlaiseJose Luis Diez-MartinJaime Sanz CaballerAnnalisa RuggeriEolia BrissotBipin P SavaniSebastian GiebelArnon NaglerFlorent MalardPublished in: Bone marrow transplantation (2021)
Optimal donor choice for a second allogeneic hematopoietic cell transplant (allo-HCT) in relapsed acute lymphoblastic leukemia (ALL) remains undefined. We compared outcomes using HLA-matched unrelated donors (MUD) versus haploidentical donors in this population. Primary endpoint was overall survival (OS). The MUD allo-HCT group comprised 104 patients (male = 56, 54%), median age 36 years, mostly (76%) with B-cell phenotype in complete remission (CR) (CR2/CR3 + = 76, 73%). The 61 patients (male = 38, 62%) in the haploidentical group were younger, median age 30 years (p = 0.002), had mostly (79%) a B-cell phenotype and the majority were also in CR at time of the second allo-HCT (CR2/CR3 + = 40, 66%). Peripheral blood stem cells was the most common cell source in both, but a significantly higher number in the haploidentical group received bone marrow cells (26% vs. 4%, p < 0.0001). A haploidentical donor second allo-HCT had a 1.5-fold higher 2-year OS (49% vs. 31%), albeit not statistically significant (p = 0.13). A longer time from first allo-HCT to relapse was associated with improved OS, leukemia-free survival, graft-versus-host disease-free-relapse-free survival, and lower cumulative incidences of relapse and non-relapse mortality. Results suggest no major OS difference when choosing either a MUD or haploidentical donor for ALL patients needing a second allo-HCT.
Keyphrases
- bone marrow
- free survival
- stem cell transplantation
- acute lymphoblastic leukemia
- peripheral blood
- end stage renal disease
- stem cells
- cell cycle arrest
- chronic kidney disease
- ejection fraction
- newly diagnosed
- cord blood
- single cell
- high dose
- prognostic factors
- mesenchymal stem cells
- acute myeloid leukemia
- peritoneal dialysis
- adipose tissue
- cell therapy
- low dose
- systemic lupus erythematosus
- cell death
- rheumatoid arthritis
- diffuse large b cell lymphoma
- signaling pathway
- pi k akt
- disease activity
- metabolic syndrome
- induced apoptosis
- endoplasmic reticulum stress