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

被引：31

作者：

Devillier, Raynier ^{[1
,2
,3
]}

Legrand, Faezeh ^{[1
]}

Rey, Jerome ^{[1
]}

Castagna, Luca ^{[1
,4
]}

Furst, Sabine ^{[1
]}

Granata, Angela ^{[1
]}

Charbonnier, Aude ^{[1
]}

Harbi, Samia ^{[1
]}

d'Incan, Evelyne ^{[1
]}

Pagliardini, Thomas ^{[1
]}

Faucher, Catherine ^{[1
]}

Lemarie, Claude ^{[5
,6
]}

Saillard, Colombe ^{[1
,3
]}

Calmels, Boris ^{[5
,6
]}

Mohty, Bilal ^{[1
]}

Maisano, Valerio ^{[1
]}

Weiller, Pierre-Jean ^{[1
,2
,3
]}

Chabannon, Christian ^{[2
,3
,5
,6
]}

Vey, Norbert ^{[1
,2
,3
]}

Blaise, Didier ^{[1
,2
,3
]}

机构：

[1] Inst Paoli Calmettes, Dept Hematol, 232 Blvd St Marguerite, Marseille, France

[2] Ctr Rech Cancerol Marseille, Inserm U1068, CNRS UMR 7258, Marseille, France

[3] Aix Marseille Univ, UM 105, Marseille, France

[4] Humanitas Canc Ctr, Dept Hematol, Rozzano, Italy

[5] Inst Paoli Calmettes, Cell Therapy Facil, Marseille, France

[6] Inserm CBT 1409, CIC Biotherapies, Marseille, France

来源：

BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION | 2018年 / 24卷 / 07期

关键词：

Allogeneic hematopoietic stem cell transplantation; Acute myeloid leukemia; Elderly; Haploidentical donor; Unrelated donor; VERSUS-HOST-DISEASE; BONE-MARROW-TRANSPLANTATION; HIGH-DOSE CYCLOPHOSPHAMIDE; ANTI-THYMOCYTE-GLOBULIN; POSTTRANSPLANTATION CYCLOPHOSPHAMIDE; HEMATOLOGIC MALIGNANCIES; MYELODYSPLASTIC SYNDROME; ANTITHYMOCYTE GLOBULIN; CHRONIC GVHD; PROPHYLAXIS;

D O I：

10.1016/j.bbmt.2018.02.002

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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. (C) 2018 American Society for Blood and Marrow Transplantation.

引用

页码：1449 / 1454

页数：6

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