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

Raynier Devillier (1, 2) , Faezeh Legrand (3) , Jerome Rey (4) , Luca Castagna (1, 2, 5) , Sabine Furst (2, 1) , Angela Granata (4) , Aude Charbonnier (4) , Samia Harbi (2, 1) , Evelyne d'Incan , Thomas Pagliardini , Catherine Faucher (6, 2, 1) , Claude Lemarie (4) , Colombe Saillard (4) , Boris Calmels (4) , Bilal Mohty (7) , Valerio Maisano , Pierre-Jean Weiller (8, 7) , Christian Chabannon (7) , Norbert Vey (7) , Didier Blaise (9, 7)

1 Département d'Hématologie [Marseille]
2 Unité de Transplantation et de Thérapie Cellulaire [Marseille]
3 RIGHT - Interactions hôte-greffon-tumeur, ingénierie cellulaire et génique - UFC (UMR INSERM 1098)
4 IPC - Institut Paoli-Calmettes
5 Department of Hemato-oncology - Transplant Unit [Milano, Italy]
6 SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD - Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale
7 CRCM - Centre de Recherche en Cancérologie de Marseille
8 Service de Médecine Interne
9 Service d’Hématologie [Institut Paoli Calmettes, Marseille]

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.

Domaines: Sciences du Vivant [q-bio]

Raynier Devillier, Faezeh Legrand, Jerome Rey, Luca Castagna, Sabine Furst, et al.. 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. BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION, 2018, 24 (7), pp.1449-1454. ⟨10.1016/j.bbmt.2018.02.002⟩. ⟨hal-02143551⟩