Older MRD vs. younger MUD in patients older than 50 years with AML in remission using post-transplant cyclophosphamide.
Simona PiemonteseMyriam LabopinGoda ChoiAnnoek E C BroersJacopo PeccatoriEllen MeijerGwendolyn Van GorkomMontserrat RoviraMaria Jesús Pascual CasconSimona SicaJan VydraAlexander Dmitrievich KulaginAlexandros SpirydonidisArnon NaglerAli BazarbachiBipin P SavaniEolia BrissotJaime SanzMohamad MohtyFabio CiceriPublished in: Leukemia (2024)
An increasing number of older patients with acute myeloid leukemia (AML) are offered an allogeneic hematopoietic stem cell transplantation (allo-HSCT). Normally, older patients have older matched related donors (MRD). Matched unrelated donors (MUD) are an important alternative, but it remains unclear whether a younger MUD is associated with better outcomes, especially in the context of post-transplant cyclophosphamide (PTCy). We compared outcomes of patients older than 50 years with AML in first complete remission (CR1) and receiving a first HSCT from a 10/10 MUD aged younger than 40 years to those receiving a graft from a MRD aged older than 50 years, using PTCy and with well-known transplant conditioning intensity (TCI) score. A total of 345 consecutive patients were included and classified according to TCI score as low, intermediate, or high. On multivariable analysis in the TCI-intermediate/high group, MUD was associated with better graft-versus-host disease-free, relapse-free survival, lower non-relapse mortality and lower relapse incidence. For patients receiving a TCI-low regimen, outcomes are independent on the type of donor. In patients with AML in CR1, older than 50 years and receiving a TCI-intermediate/high conditioning regimen using PTCy, a MUD younger than 40 years is preferable over a MRD older than 50 years.
Keyphrases
- acute myeloid leukemia
- allogeneic hematopoietic stem cell transplantation
- end stage renal disease
- community dwelling
- physical activity
- middle aged
- free survival
- ejection fraction
- newly diagnosed
- chronic kidney disease
- prognostic factors
- low dose
- peritoneal dialysis
- type diabetes
- cardiovascular disease
- risk factors
- acute lymphoblastic leukemia
- patient reported outcomes
- systemic lupus erythematosus
- adipose tissue
- skeletal muscle
- rheumatoid arthritis
- metabolic syndrome
- insulin resistance
- high intensity
- drug induced
- hematopoietic stem cell