Haploidentical vs sibling, unrelated, or cord blood hematopoietic cell transplantation for acute lymphoblastic leukemia
Matthew J. Wieduwilt, Leland Metheny, Mei‐Jie Zhang, Hailin Wang, Noel Estrada‐Merly, David I. Marks, A. Samer Al‐Homsi, Lori Muffly, Nelson J. Chao, David A. Rizzieri, Robert Peter Gale, Shahinaz M. Gadalla, Mitchell S. Cairo, Alberto Mussetti, Steven D. Gore, Vijaya Raj Bhatt, Sagar S. Patel, Fotios V. Michelis, Yoshihiro Inamoto, Sherif M. Badawy, Edward A. Copelan, Neil Palmisiano, Mohamed A. Kharfan‐Dabaja, Hillard M. Lazarus, Siddhartha Ganguly, Christopher Bredeson, Miguel Ángel Díaz, Ryan D. Cassaday, Bipin N. Savani, Karen K. Ballen, Rodrigo Martino, Baldeep Wirk, Ulrike Bacher, Mahmoud Aljurf, Asad Bashey, Hemant S. Murthy, Jean A. Yared, Ibrahim Aldoss, Nosha Farhadfar, Hongtao Liu, Hisham Abdel‐Azim, Edmund K. Waller, Melhem Solh, Matthew D. Seftel, Marjolein van der Poel, Michael R. Grunwald, Jane L. Liesveld, Rammurti T. Kamble, Joseph P. McGuirk, Reinhold Munker, Jean‐Yves Cahn, Jong Wook Lee, César O. Freytes, Maxwell M. Krem, Lena E. Winestone, Usama Gergis, Sunita Nathan, Richard F. Olsson, Leo F. Verdonck, Akshay Sharma, Olle Ringdén, Brian D. Friend, Jan Černý, Hannah Choe, Saurabh Chhabra, Taiga Nishihori, Sachiko Seo, Biju George, Lee Ann Baxter‐Lowe, Gerhard Hildebrandt, Marcos de Lima, Mark R. Litzow, Partow Kebriaei, Christopher S. Hourigan, Muhammad Bilal Abid, Daniel J. Weisdorf, Wael Saber
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.