Haploidentical vs sibling, unrelated, or cord blood hematopoietic cell transplantation for acute lymphoblastic leukemia

Matthew J. Wieduwilt, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK.
Leland Metheny, University Hospitals Seidman Cancer Center, Cleveland, OH.
Mei-Jie Zhang, Center for International Blood and Marrow Transplant Research, Department of Medicine, and.Follow
Hai-Lin Wang, Center for International Blood and Marrow Transplant Research, Department of Medicine, and.Follow
Noel Estrada-Merly, Center for International Blood and Marrow Transplant Research, Department of Medicine, and.
David I. Marks, Adult Bone Marrow Transplant, University Hospitals Bristol National Health Service Trust, Bristol, UK.
A Samer Al-Homsi, New York University Langone Health, New York, NY.
Lori Muffly, Division of Blood and Marrow Transplantation, Stanford University, Stanford, CA.
Nelson Chao, Division of Cell Therapy and Hematology, Department of Medicine, Duke University Medical Center, Durham, NC.Follow
David Rizzieri, Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC.
Robert Peter Gale, Haematology Research Centre, Department of Immunology and Inflammation, Imperial College London, London, UK.Follow
Shahinaz M. Gadalla, Division of Cancer Epidemiology and Genetics, Clinical Genetics Branch, National Cancer Institute, National Institutes of Health, Rockville, MD.Follow
Mitchell Cairo, Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Department of Pediatrics, New York Medical College, Valhalla, NY.Follow
Alberto Mussetti, Hematology Department, Institut Catalá d'Oncologia-Hospitalet, Barcelona, Spain.
Steven Gore, Yale New Haven Hospital, New Haven, CT.
Vijaya Raj Bhatt, The Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE.Follow
Sagar S. Patel, Blood and Marrow Transplant Program, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT.
Fotios V. Michelis, Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, Toronto, Canada.
Yoshihiro Inamoto, Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan.
Sherif M. Badawy, Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.Follow
Edward Copelan, Deparment of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC.
Neil Palmisiano, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA.
Mohamed A. Kharfan-Dabaja, Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL.
Hillard M. Lazarus, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH.
Siddhartha Ganguly, Division of Hematological Malignancies and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS.Follow
Christopher Bredeson, The Ottawa Hospital Transplant and Cellular Therapy Program, Ottawa, ON, Canada.Follow
Miguel Angel Diaz Perez, Department of Hematology/Oncology, Hospital Infantil Universitario Niño Jesus, Madrid, Spain.
Ryan Cassaday, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA.
Bipin N. Savani, Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.
Karen Ballen, Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA.
Rodrigo Martino, Division of Clinical Hematology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain.
Baldeep Wirk, Bone Marrow Transplant Program, Penn State Cancer Institute, Hershey, PA.
Ulrike Bacher, Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

Abstract

The role of haploidentical hematopoietic cell transplantation (HCT) using posttransplant cyclophosphamide (PTCy) for acute lymphoblastic leukemia (ALL) is being defined. We performed a retrospective, multivariable analysis comparing outcomes of HCT approaches by donor for adults with ALL in remission. The primary objective was to compare overall survival (OS) among haploidentical HCTs using PTCy and HLA-matched sibling donor (MSD), 8/8 HLA-matched unrelated donor (MUD), 7 /8 HLA-MUD, or umbilical cord blood (UCB) HCT. Comparing haploidentical HCT to MSD HCT, we found that OS, leukemia-free survival (LFS), nonrelapse mortality (NRM), relapse, and acute graft-versus-host disease (aGVHD) were not different but chronic GVHD (cGVHD) was higher in MSD HCT. Compared with MUD HCT, OS, LFS, and relapse were not different, but MUD HCT had increased NRM (hazard ratio [HR], 1.42; P = .02), grade 3 to 4 aGVHD (HR, 1.59; P = .005), and cGVHD. Compared with 7/8 UD HCT, LFS and relapse were not different, but 7/8 UD HCT had worse OS (HR, 1.38; P = .01) and increased NRM (HR, 2.13; P ≤ .001), grade 3 to 4 aGVHD (HR, 1.86; P = .003), and cGVHD (HR, 1.72; P ≤ .001). Compared with UCB HCT, late OS, late LFS, relapse, and cGVHD were not different but UCB HCT had worse early OS (≤18 months; HR, 1.93; P < .001), worse early LFS (HR, 1.40; P = .007) and increased incidences of NRM (HR, 2.08; P < .001) and grade 3 to 4 aGVHD (HR, 1.97; P < .001). Haploidentical HCT using PTCy showed no difference in survival but less GVHD compared with traditional MSD and MUD HCT and is the preferred alternative donor HCT option for adults with ALL in complete remission.

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Blood advances

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