Haploidentical transplantation is associated with better overall survival when compared to single cord blood transplantation: an EBMT-Eurocord study of acute leukemia patients conditioned with thiotepa, busulfan, and fludarabine
Por:
Giannotti, F, Labopin, M, Shouval, R, Sanz, J, Arcese, W, Angelucci, E, Sierra, J, Santasusana, JMR, Santarone, S, Benedetto, B, Rambaldi, A, Saccardi, R, Blaise, D, Carella, MA, Rocha, V, Baron, F, Mohty, M, Ruggeri, A, Nagler, A
Publicada:
30 ago 2018
Resumen:
Background: Thiotepa-busulfan-fludarabine (TBF) is a widely used conditioning regimen in single umbilical cord blood transplantation (SUCBT). More recently, it was introduced in the setting of non-T cell depleted haploidentical stem cell transplantation (NTD-Haplo). Whether TBF based conditioning provides additional benefit in transplantation from a particular alternative donor type remains to be established.
Methods: This was a retrospective study based on an international European registry. We compared outcomes of de-novo acute myeloid leukemia patients in complete remission receiving NTD-Haplo (n = 186) vs. SUCBT (n = 147) following myeloablative conditioning (MAC) with TBF. Median follow-up was 23 months. Treatment groups resembled in baseline characteristics.
Results: SUCBT was associated with delayed engraftment and higher graft failure. In multivariate analysis no statistically significant differences were observed between the two groups in terms of acute or chronic graft-versus-host disease (GvHD) (HR = 1.03, p = 0.92 or HR = 1.86, p = 0.21) and relapse incidence (HR = 0.8, p = 0.65). Non-relapse mortality (NRM) was significantly higher in SUCBT as compared to NTD-Haplo (HR = 2.63, p = 0.001); moreover, SUCBT did worse in terms of overall survival (HR = 2.18, p = 0.002), leukemia-free survival (HR = 1.94, p = 0.007), and GvHD relapse-free survival (HR = 2.38, p = 0.0002).
Conclusions: Our results suggest that TBF-MAC might allow for a potent graft-versus-leukemia, regardless of the alternative donor type. Furthermore, in patients receiving TBF-MAC, survival with NTD-Haplo may be better compared to SUCBT due to decreased NRM.
Filiaciones:
Giannotti, F:
St Antoine Hosp, Dept Hematol & Cell Therapy, Paris, France
Labopin, M:
St Antoine Hosp, Dept Hematol & Cell Therapy, Paris, France
Hosp St Antoine, Acute Leukemia Working Party EBMT Paris Off, Paris, France
Shouval, R:
Tel Aviv Univ, Sackler Sch Med, Chaim Sheba Med Ctr, Div Hematol, IL-52621 Ramat Gan, Israel
Tel Aviv Univ, Sackler Sch Med, Chaim Sheba Med Ctr, Bone Marrow Transplantat Div, IL-52621 Ramat Gan, Israel
Chaim Sheba Med Ctr, Dr Pinchas Bornstein Talpiot Med Leadership Progr, Tel Hashomer, Israel
Sanz, J:
Hosp Univ & Politecn La Fe, Valencia, Spain
Inst Carlos III, CIBERONC, Madrid, Spain
Arcese, W:
Policlin Univ Tor Vergata, Tor Vergata Univ Rome, Stem Cell Transplant Unit, Rome Transplant Network, Rome, Italy
Angelucci, E:
Osped Policlin San Martino, Hematol & Transplant Unit, Genoa, Italy
Sierra, J:
Hosp Santa Creu & Sant Pau, Hematol Dept, Barcelona, Spain
Santasusana, JMR:
ICO Hosp Univ Germans Trias & Pujol, Josep Carreras Res Inst, Badalona, Spain
Santarone, S:
Osped Civile, Dipartimento Ematol Med Trasfus & Biotecnol, Pescara, Italy
Benedetto, B:
SSCVD Trapianto Cellule Staminali AOU Citta Salut, Turin, Italy
Rambaldi, A:
Azienda Osped Papa Giovanni XXIII, Hematol & Bone Marrow Transplant Unit, Bergamo, Italy
Saccardi, R:
Azienda Osped Univ Careggi, Cell Therapy & Transfus Med Unit, Florence, Italy
Blaise, D:
Inst Paoli Calmettes, Ctr Rech Cancerol Marseille, Programme Transplantat & Therapie Cellulaire, Marseille, France
Carella, MA:
IRCCS, Casa Sollievo Sofferenza, Dept Hematoooncol, Setm Cell Transplant Unit, San Giovanni Rotondo, Italy
Rocha, V:
Univ Paris Diderot, Hop St Louis, Eurocord, Paris, France
Univ Oxford, Churchill Hosp, Dept Hematol, NHS BT, Oxford NHS BT, England
Univ Sao Paulo, Serv Hematol Hemoterapia & Terapia Celular, Sao Paulo, SP, Brazil
Baron, F:
Univ Liege, GIGA I3, Liege, Belgium
Mohty, M:
St Antoine Hosp, Dept Hematol & Cell Therapy, Paris, France
Hosp St Antoine, Acute Leukemia Working Party EBMT Paris Off, Paris, France
Ruggeri, A:
St Antoine Hosp, Dept Hematol & Cell Therapy, Paris, France
IRCCS Bambino Gesu Childrens Hosp, Dept Pediat Hematol & Oncol, Piazza S Onofrio 4, I-00165 Rome, Italy
Nagler, A:
Hosp St Antoine, Acute Leukemia Working Party EBMT Paris Off, Paris, France
Tel Aviv Univ, Sackler Sch Med, Chaim Sheba Med Ctr, Div Hematol, IL-52621 Ramat Gan, Israel
Tel Aviv Univ, Sackler Sch Med, Chaim Sheba Med Ctr, Bone Marrow Transplantat Div, IL-52621 Ramat Gan, Israel
Gold, Green Published
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