Unmanipulated haploidentical stem cell transplantation in adults with acute lymphoblastic leukemia: a study on behalf of the Acute Leukemia Working Party of the EBMTReport as inadecuate




Unmanipulated haploidentical stem cell transplantation in adults with acute lymphoblastic leukemia: a study on behalf of the Acute Leukemia Working Party of the EBMT - Download this document for free, or read online. Document in PDF available to download.

* Corresponding author 1 ALWP-EBMT & Département d-hématologie et de thérapie cellulaire AP-HP Hôpital Saint-Antoine 2 Department of Medicine, Division of Hematology and Clinical Immunology Perugia, Italy 3 Acute Leukaemia Working Party - ALWP - Groupe de travail sur la leucémie aiguë AP-HP Hôpital Saint Antoine 4 Department of Hematology II Genova, Italy 5 Università cattolica del Sacro Cuore Roma, Italy 6 Hematology and Bone Marrow Transplantation Unit Milan, Italy 7 Hematology Department Kocaeli, Turkey 8 Bone Marrow Transplantation Center Zhejiang, China 9 Hematology and Transplantology St. Petersburg, Russian Federation 10 Department of Hematology Rome, Italy 11 Department of Hematology Jiangsu, China 12 Stem Cell Transplant Unit Antalya, Turkey 13 Department of Internal Medicine III Munich, Germany 14 Department of Hematology and Trasfusional Medicine Pescara, Italy 15 Department of Bone Marrow Transplantation and Onco-Hematology Gliwice, Poland 16 Department of Hematology and Bone Marrow Transplantation Ramat Gan, Israel

Abstract : AbstractBackgroundAllogenic hematopoietic stem cell transplantation allo-SCT is the most effective post-remission treatment for adults with high-risk acute lymphoblastic leukemia ALL. The aim of the study was to analyze results of unmanipulated haploidentical allo-SCT haplo-SCT for adults with ALL and to identify prognostic factors.MethodsWe performed a retrospective analysis on 208 adults transplanted in EBMT centers from 2007 to 2014.ResultsMedian age at haplo-SCT was 32 years and median follow-up, 31 months. Forty-four percent of the patients were in first complete remission CR1. Stem cell source was the bone marrow BM for 43% and peripheral blood PB for 57% of patients. Myeloablative conditioning MAC was used for 66% and reduced intensity regimen RIC for 34% of patients. GVHD prophylaxis was based on post-transplant cyclophosphamide PT-Cy for 118 57% or on anti-thymocyte-globulin ATG for 90 43% plus standard prophylaxis. One hundred eighty-four 92% patients achieved engraftment. Cumulative incidence CI of grade II–IV acute-graft-versus-host-disease GVHD was 31%, grade III–IV 11%, and chronic GVHD 29%. Non-relapse mortality NRM and relapse-incidence RI were 32 and 37%, respectively. Overall survival OS, leukemia-free survival LFS, and GVHD-free, relapse-free-survival GRFS at 3 years were 33, 31, and 26%. For patients in CR1, OS, LFS, and GRFS were 52, 47, and 40%, respectively. Disease status was the main factor associated with transplant outcomes. Use of BM was independently associated with improvement in NRM, acute GVHD, GRFS, LFS, and OS.ConclusionsUnmanipulated haplo-SCT may be considered a valid option for adult patients with high-risk ALL lacking HLA identical donor preferably in early disease status.

Keywords : Non-TCD haploidentical Adults Acute lymphoblastic leukemia Allogenic stem cell transplantation





Author: Nicole Santoro - Annalisa Ruggeri - Myriam Labopin - Andrea Bacigalupo - Fabio Ciceri - Zafer Gülbaş - He Huang - Boris Afanasy

Source: https://hal.archives-ouvertes.fr/



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