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01.12.2018 | Research | Ausgabe 1/2018 Open Access

Journal of Hematology & Oncology 1/2018

Haploidentical transplantation is associated with better overall survival when compared to single cord blood transplantation: an EBMT-Eurocord study of acute leukemia patients conditioned with thiotepa, busulfan, and fludarabine

Zeitschrift:
Journal of Hematology & Oncology > Ausgabe 1/2018
Autoren:
Federica Giannotti, Myriam Labopin, Roni Shouval, Jaime Sanz, William Arcese, Emanuele Angelucci, Jorge Sierra, Josep-Maria Ribera Santasusana, Stella Santarone, Bruno Benedetto, Alessandro Rambaldi, Riccardo Saccardi, Didier Blaise, Michele Angelo Carella, Vanderson Rocha, Frederic Baron, Mohamad Mohty, Annalisa Ruggeri, Arnon Nagler
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s13045-018-0655-8) contains supplementary material, which is available to authorized users.
Federica Giannotti, Myriam Labopin and Roni Shouval contributed equally to this work.

Abstract

Background

Thiotepa-busulfan-fludarabine (TBF) is a widely used conditioning regimen in single umbilical cord blood transplantation (SUCBT). More recently, it was introduced in the setting of non-T cell depleted haploidentical stem cell transplantation (NTD-Haplo). Whether TBF based conditioning provides additional benefit in transplantation from a particular alternative donor type remains to be established.

Methods

This was a retrospective study based on an international European registry. We compared outcomes of de-novo acute myeloid leukemia patients in complete remission receiving NTD-Haplo (n = 186) vs. SUCBT (n = 147) following myeloablative conditioning (MAC) with TBF. Median follow-up was 23 months. Treatment groups resembled in baseline characteristics.

Results

SUCBT was associated with delayed engraftment and higher graft failure. In multivariate analysis no statistically significant differences were observed between the two groups in terms of acute or chronic graft-versus-host disease (GvHD) (HR = 1.03, p = 0.92 or HR = 1.86, p = 0.21) and relapse incidence (HR = 0.8, p = 0.65). Non-relapse mortality (NRM) was significantly higher in SUCBT as compared to NTD-Haplo (HR = 2.63, p = 0.001); moreover, SUCBT did worse in terms of overall survival (HR = 2.18, p = 0.002), leukemia-free survival (HR = 1.94, p = 0.007), and GvHD relapse-free survival (HR = 2.38, p = 0.0002).

Conclusions

Our results suggest that TBF-MAC might allow for a potent graft-versus-leukemia, regardless of the alternative donor type. Furthermore, in patients receiving TBF-MAC, survival with NTD-Haplo may be better compared to SUCBT due to decreased NRM.

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Zusatzmaterial
Additional file 1: Table S1. HLA haploidentical transplantation strategy. Table S2. GvHD prophylaxis in patients receiving NTD-Haplo. Table S3. GvHD prophylaxis in patients receiving single umbilical cord blood transplantation. Table S4. Causes of Death. Table S5. The impact of MRC cytogenetic risk groups. (DOCX 19 kb)
13045_2018_655_MOESM1_ESM.docx
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