HLA-Matched Sibling versus Unrelated versus Haploidentical Related Donor Allogeneic Hematopoietic Stem Cell Transplantation for Patients Aged Over 60 Years with Acute Myeloid Leukemia: A Single-Center Donor Comparison

Abstract

Haploidentical related donor (HRD) allogeneic hematopoietic stem cell transplantation (allo-HSCT) was developed as a valid option for the treatment of acute myeloid leukemia (AML) in the absence of a matched donor. However, many investigators are reluctant to consider the use of this alternative in elderly patients, anticipating high morbidity. Here, we report a single-center comparison of HRD versus matched sibling donor (MSD) and unrelated donor (UD) allo-HSCT for patients with AML aged ≥60 years. Ninety-four patients (MSD: n = 31; UD: n = 30; HRD: n = 33) were analyzed. The median age was 65 (range, 60 to 73) years. We observed a higher cumulative incidence of grade 3 to 4 acute graft-versus-host disease (GVHD) after UD allo-HSCT (MSD versus UD versus HRD: 3% versus 33% versus 6%, respectively; P = .006). Two-year cumulative incidence of moderate or severe chronic GVHD was 17%, 27%, and 16% in the MSD, UD, and HRD groups, respectively (P = .487). No difference was observed in the 2-year cumulative incidence of relapse or nonrelapse mortality (NRM) (relapse: MSD versus UD versus HRD: 32% versus 25% versus 25%, respectively; P = .411; NRM: MSD versus UD versus HRD: 19% versus 27% versus 24%, respectively; P = .709). At 2 years, progression-free survival, overall survival, and GVHD- and relapse-free survival were 48%, 50%, and 39%, respectively, in the MSD group; 48%, 51%, and 23%, respectively, in the UD group; and 50%, 52%, and 32%, respectively, in the HRD group, without statistically significant differences between the groups. We conclude that HRD allo-HSCT is highly feasible and no less efficient than MSD or UD allo-HSCT in patients with AML aged ≥60 years. Thus, the absence of a HLA-identical donor should not limit the consideration of allo-HSCT for the treatment of AML.

Outcomes of Haploidentical Transplantation in Patients with Relapsed Multiple Myeloma: An EBMT/CIBMTR Report

“…In hematologic malignancies overall, allo-HCT is traditionally performed with use of HLA-identical sibling donors or unrelated donors, although it may be underutilized in highrisk MM. Because such donors are frequently unavailable, especially for non-Caucasian patients, allo-HCT from haploidentical related donors is being increasingly used, with decreased nonrelapse mortality (NRM) and favorable outcomes in disease control reported [7][8][9]. Data on the use of haploidentical transplantation in MM remain limited, although 2 small retrospective studies of haploidentical allo-HCT have reported encouraging results in patients with MM [10,11].…”

Improved survival after offspring donor transplant compared with older aged‐matched siblings for older leukaemia patients

“…The non‐significant trend for lower risk of chronic GVHD after haploidentical HCT as compared with matched HCT is in accordance with other reports (Blaise et al ., ; Devillier et al ., ; Robinson et al ., ; Santoro et al ., ). The possible explanation may be as follows.…”

“…These data suggest donor source and HLA-matching are not significantly correlated with transplant outcomes in these settings. Regardless, these publications have mainly described younger patients and lack data from older populations (Blaise et al, 2016;Devillier et al, 2018;Santoro et al, 2018).…”

Haploidentical Hematopoietic Stem Cell Transplantation Followed by ‘Post-Cyclophosphamide’: The Future of Allogeneic Stem Cell Transplant

“…In large part due to the advent of new conditioning and GvHD prophylactic regimens, such complications have been significantly reduced. In multiple recent studies of transplants for hematologic malignancies, haploidentical transplants had noninferior and, at times, superior outcomes compared with MMUDs, UCB, and even matched donors [5,7,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. In this review, we will compare haploidentical donor outcomes with outcomes using other donor sources.…”

“…Importantly, these results were found to be similar in patients over 60 years of age undergoing Allo-HCT. Santoro et al and Devillier et al evaluated patients in this age group with AML who received transplants from either haploidentical donors or MUDs [5,24]. Neither study showed any difference in OS, LFS, or NRM [5,24].…”