Outcome after allogeneic stem cell transplantation with haploidentical versus HLA-matched donors in patients with higher-risk MDS
Claire Michel, Marie Robin, Stéphane Morisset, Didier Blaise, Johan Maertens, Patrice Chevalier, Cristina Castilla‐Llorente, Édouard Forcade, Patrice Céballos, Ibrahim Yakoub‐Agha, Xavier Poiré, Martin Carré, Jacques‐Olivier Bay, Yves Béguin, Michaël Loschi, Anne Huynh, Gaëlle Guillerm, Sylvie François, Jean-Baptiste Méar, Rémy Duléry, Felipe Suárez, Karin Bilger, Jérôme Cornillon, Yves Chalandon, Natacha Maillard, Hélène Labussière‐Wallet, A Charbonnier, Pascal Turlure, Ana Berceanu, Sylvain Chantepie, Sébastien Maury, Ali Bazarbachi, Anne‐Lise Ménard, Stéphanie Nguyen‐Quoc, Marie‐Thérèse Rubio, Maud D’Aveni
Abstract
Allogeneic hematopoietic stem cell transplantation remains the best curative option for higher-risk myelodysplastic syndrome. The presence of monosomal karyotype and/or complex karyotype abnormalities predicts inferior survival after allo-SCT in MDS patients. Haploidentical allo-SCT has been increasingly used in acute leukemia (AL) and has similar results as using HLA-matched donors, but data on higher-risk MDS is sparse. We compared outcomes in 266 patients with higher-risk MDS after HLA-matched sibling donor (MSD, n = 79), HLA-matched unrelated donor (MUD, n = 139) and HLA haploidentical donor (HID, n = 48) from 2010 to 2019. Median donor age differed between the three groups (p < 0.001). The overall survival was significantly different between the three groups with a better OS observed in the MUD group (p = 0.014). This observation could be explained by a higher progression-free survival with MUD (p = 0.014). The cumulative incidence of grade 2-4 acute GvHD was significantly higher in the HID group (p = 0.051). However, in multivariable analysis, patients transplanted using an HID had comparable mortality to patients transplanted using a MUD (subdistribution hazard ratio [sHR]: 0.58 [0.32-1.07]; p = 0.080) and a MSD ([sHR]: 0.56 [0.28-1.11]; p = 0.094). MUD do not remain a significant positive predictor of survival, suggesting that beyond the donor-recipient HLA matching, the donor age might impact recipient outcome.