Haploidentical transplant in adult patients with acute lymphoblastic leukemia in Argentina: a comparison with matched related and unrelated donors.
Ana Lisa BasquieraMariano BerroSebastián YantornoMartín CastroAlejandro RequejoMiguel SorrentinoDaniel SutovskyDiego GiuntaSilvina PalmerAdriana VitriuGonzalo FeriniGeorgina BendekMilagros SzelagowskiMaría Leticia RapánNicolás Fernandez EscobarPatricio DuarteAmalia CeruttiMaximiliano CattaneoJuliana Martinez-RolónGregorio JaimovichJavier BordoneVera MilovicGustavo KusminskyJorge A Arbelbidenull nullPublished in: Bone marrow transplantation (2019)
We aimed at analyzing the outcome of allogeneic stem cell transplant (ASCT) in adult patients with acute lymphoblastic leukemia (ALL), comparing Haploidentical (Haplo) with HLA-matched (sibling and unrelated) donors. Between 2008 and 2017, we collected data from 236 patients (median age 31 years; range 16-64; 90% HCT-CI 0-1) who underwent unmanipulated ASCT in first complete remission and subsequent remissions in 15 Argentinian centers. Donors were HLA-matched (n = 175; 74%) and Haplo (n = 61; 26%). Two-year overall survival (OS) was 55% (95% CI 47-63) for the HLA-matched group and 49% (95% CI 34-62) for the Haplo group (p = 0.351). For OS, crude HR, adjusted HR for covariates (HR 1.24; 95% CI 0.77-1.99; p = 0.363) and HR including a propensity score in the model (HR 1.22; 95% CI 0.71-2.08; p = 0.414) showed no impact of donor category on the OS. No difference was found in terms of nonrelapse mortality, relapse, leukemia-free survival, and grade 3-4 acute graft-versus-host disease (GVHD); 2-year incidence of chronic GVHD was higher in HLA-matched vs Haplo group (p = 0.028). Patients with ALL who underwent ASCT were young subjects with low HCT-CI. In this setting, a Haplo donor represents an alternative widely available in the absence of an HLA-matched donor. Relapse remains a challenge for all donor categories.
Keyphrases
- free survival
- acute lymphoblastic leukemia
- stem cell transplantation
- bone marrow
- stem cells
- allogeneic hematopoietic stem cell transplantation
- end stage renal disease
- cord blood
- risk factors
- newly diagnosed
- liver failure
- acute myeloid leukemia
- ejection fraction
- low dose
- chronic kidney disease
- kidney transplantation
- peripheral blood
- cardiovascular events
- peritoneal dialysis
- high dose
- cell proliferation
- systemic lupus erythematosus
- coronary artery disease
- electronic health record
- respiratory failure
- disease activity
- cardiovascular disease
- mesenchymal stem cells
- ulcerative colitis