Is There a Stronger Graft-Versus-Leukemia Effect Using Hla-Haploidentical Donors Compared With Hla-Identical Siblings? Publisher Pubmed



Ringden O¹ ; Labopin M² ; Ciceri F³ ; Velardi A⁴ ; Bacigalupo A⁵ ; Arcese W⁶ ; Ghavamzadeh A⁷ ; Hamladji RM⁸ ; Schmid C⁹ ; Nagler A^{2, 10} ; Mohty M² Show Affiliations
Source: Leukemia Published:2016

Abstract

Haploidentical hematopoietic stem cell transplants (HSCTs) are increasingly used, but it is unknown whether they have a stronger graft-versus-leukemia (GVL) effect. We analyzed 10 679 acute leukemia patients who underwent HSCT from an HLA-matched sibling donor (MSD, n=9815) or a haploidentical donor (≥2 HLA-antigen disparity, n=864) between 2007 and 2012, reported to the European Group for Blood and Marrow Transplantation. In a Cox regression model, acute and chronic graft-versus-host disease (GVHD) was added as time-dependent variables. There was no difference in probability of relapse between recipients of haploidentical and MSD grafts. Factors of importance for relapse after T-cell-replete grafts included remission status at HSCT, Karnofsky score ≤80, acute GVHD of grade II or higher and chronic GVHD (P<10 -5). Patients with post-transplant cyclophosphamide (n=194) had similar outcome as other T-cell-replete haploidentical transplants (n=369). Non-relapse mortality was significantly higher in the haploidentical group compared with that in MSD patients (P<10 -5). Leukemia-free survival was superior in the MSD patients receiving T-cell-replete (P<10 -5) or T-cell-depleted grafts (P=0.0006). The risk of relapse was the same in acute leukemia patients who received haploidentical donor grafts as in those given MSD transplants, suggesting a similar GVL effect. © 2016 Macmillan Publishers Limited.