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

Abstract BACKGROUND Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potentially curative therapeutic option for patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS). Increasing data supports the utility of haploidentical related donor (HID) HSCT in fit older patients and resulting in improvement of outcomes. This study compared the outcomes of acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) patients age ≥50 years underwent haploidentical related donor (HID) or matched sibling donor (MSD) allogeneic hematopoietic stem cell transplantation (allo-HSCT).METHODS We provided HID transplantation to 38 patients of AML/MDS age ≥50 years and compared their outcomes with 55 patients of the same ages who underwent matched sibling donor (MSD) transplantation.RESULTS The 100-day cumulative incidence of II-IV° acute graft-versus-host disease (GVHD) were 34.2 ± 7.7% and 23.6 ± 5.7%, respectively, in HID and MSD groups (P = 0.189), and III-IV° acute GVHD were similar between two groups (5.3% and 7.3%, respectively, P=0.700). The 2-year cumulative incidence of limited and extensive chronic GVHD was not statistically different in HID and MSD groups(22.8 ± 10.8% vs. 18.2 ± 6.0% and 18.3 ± 10.4% vs. 22.1 ± 6.8%, P = 0.890 and P=0.424, respectively). The 2-year cumulative incidences of relapse (29.5±10.3% and 20.7 ±6.1%, P=0.458), 2-year overall survival (58.5±9.7% and 67.9±6.8%, P=0.373), 2-year transplant-related mortality (17.3±6.4% and 15.0±5.3%, P=0.717), 2-year progression free survival (56.8±9.7% and 64.6±7.4%, P=0.312) were similar in the two groups.CONCLUSION We conclude that HID allo-SCT is feasible and safe for elderly AML/MDS patients.

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Donor lymphocyte infusions after first allogeneic hematopoietic stem-cell transplantation in adults with acute myeloid leukemia: a single-center landmark analysis

Annals of Hematology ◽

10.1007/s00277-021-04494-z ◽

2021 ◽

Author(s):

Andrés R. Rettig ◽

Gabriele Ihorst ◽

Hartmut Bertz ◽

Michael Lübbert ◽

Reinhard Marks ◽

...

Keyword(s):

Acute Myeloid Leukemia ◽

Stem Cell ◽

Hematopoietic Stem Cell Transplantation ◽

Stem Cell Transplantation ◽

Myeloid Leukemia ◽

Risk Marker ◽

Single Center ◽

Hematopoietic Stem ◽

Acute Myeloid ◽

Donor Lymphocyte Infusions

AbstractAllogeneic hematopoietic stem cell transplantation (allo-HSCT) is potentially curative for acute myeloid leukemia (AML). The inherent graft-versus-leukemia activity (GvL) may be optimized by donor lymphocyte infusions (DLI). Here we present our single-center experience of DLI use patterns and effectiveness, based on 342 consecutive adult patients receiving a first allo-HSCT for AML between 2009 and 2017. The median age at transplantation was 57 years (range 19–79), and the pre-transplant status was active disease in 58% and complete remission (CR) in 42% of cases. In a combined landmark analysis, patients in CR on day +30 and alive on day +100 were included. In this cohort (n=292), 93 patients received cryopreserved aliquots of peripheral blood-derived grafts for DLI (32%) and median survival was 55.7 months (2-year/5-year probability: 62%/49%). Median survival for patients receiving a first dose of DLI “preemptively,” in the absence of relapse and guided by risk marker monitoring (preDLI; n=42), or only after hematological relapse (relDLI; n=51) was 40.9 months (2-year/5-year: 64%/43%) vs 10.4 months (2-year/5-year: 26%/10%), respectively. Survival was inferior when preDLI was initiated at a time of genetic risk marker detection vs mixed chimerism or clinical risk only. Time to first-dose preDLI vs time to first-dose relDLI was similar, suggesting that early warning and intrinsically lower dynamics of AML recurrence may contribute to effectiveness of preDLI-modified GvL activity. Future refinements of the preemptive DLI concept will benefit from collaborative efforts to diagnose measurable residual disease more reliably across the heterogeneous genomic spectrum of AML.

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