Allogeneic hematopoietic cell transplantation for older patients with AML with active disease. A study from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT)

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Enrico Maffini - , IRCCS Azienda Ospedaliero-Universitaria di Bologna (Author)
  • Myriam Labopin - , EBMT ALWP Statistical Unit, Paris, France. (Author)
  • Nicolaus Kröger - , University Hospital Hamburg Eppendorf (Author)
  • Jürgen Finke - , University Medical Center Freiburg (Author)
  • Matthias Stelljes - , University Hospital Münster (Author)
  • Thomas Schroeder - , University Hospital Essen (Author)
  • Herman Einsele - , University Hospital of Würzburg (Author)
  • Johanna Tischer - , Hospital of the Ludwig-Maximilians-University (LMU) Munich (Author)
  • Martin Bornhäuser - , Department of Internal Medicine I, University Hospital Carl Gustav Carus Dresden (Author)
  • Wolfgang Bethge - , University Hospital Tübingen (Author)
  • Arne Brecht - , DKD Helios Klinik Wiesbaden (Author)
  • Wolf Rösler - , University Hospital at the Friedrich-Alexander University Erlangen-Nürnberg (Author)
  • Peter Dreger - , University Hospital Heidelberg (Author)
  • Kerstin Schäfer-Eckart - , Nuremberg Clinic (Author)
  • Jakob Passweg - , University Hospital Basel (Author)
  • Igor Wolfgang Blau - , Charité – Universitätsmedizin Berlin (Author)
  • Arnon Nagler - , Sheba Medical Center at Tel Hashomer (Author)
  • Fabio Ciceri - , IRCCS Hospital San Raffaele - Milano (Author)
  • Mohamad Mohty - , Assistance publique – Hôpitaux de Paris, Sorbonne Université (Author)

Abstract

Older adults with acute myeloid leukemia (AML) refractory to initial or reinduction chemotherapy have a dismal prognosis if they do not undergo hematopoietic stem-cell transplantation (HCT). However, data assessing HCT outcomes from different donors are scarce. We evaluated results from a retrospective analysis on patients aged ≥70 years, with AML not in remission who received an allogeneic HCT from HLA-matched sibling donor (MSD), HLA-10/10 matched unrelated donor (MUD), or T-cell replete haploidentical (Haplo) donor, from 2010 to 2021, reported to the ALWP-EBMT database. A total of 360 patients (median age 72 years, range 70-79) were included in the analysis. Median follow-up for the entire population was 35.5 months. Donors were MSD (n = 58), 10/10 HLA-MUD (n = 228), and Haplo (n = 74). A total of 213 (59.2%) patients were primary induction failures, while 147 (40.8%) were in first or subsequent relapse. Graft source was peripheral blood in 92% of the patients. Patients transplanted from Haplo donors more frequently received marrow grafts (p < 0.01) and presented the combination female donor to male recipient (p < 0.01). The overall 2-year rates of overall survival (OS) and leukemia-free survival (LFS) were: 62.4% (95% CI 47.2-74.3) and 47.6% (95% CI 33.1-60.8) for MSD, 43% (95% CI 35.8-49.9), and 37.5% (95% CI 30.7-44.4) for MUD, and 25.9% (95% CI 15.8-37.2), and 26.5% (95% CI 16.3-37.8) for recipients of Haplo transplants. The 2-year cumulative incidence of relapse (RI) was slightly lower for Haplo recipients at 29.6% (95% CI 19-40.9), for MUD it was 30.2% (95% CI 23.9-36.7), and for MSD 34.9% (95% CI 22-48.2); counterbalanced by a higher incidence of non-relapse mortality (NRM) of 43.9% (95% CI 31.6-55.6) for Haplo recipients, 32.2% (95% CI 26-33.1) for MUD and 17.5% (95% CI 8.4-29.3) for MSD. Graft-versus-host disease (GVHD-free, relapse-free survival (GRFS) was 35.3% (95% CI 22.3-48.5) for MSD, 29.6% (95% CI 23.2-36.2) for MUD, and 19.2% (95% CI 10.7-29.6) for Haplo patients. In the multivariate model, compared to the referent group of MSD recipients, the risk of NRM was higher among patients transplanted from Haplo donors ([hazard ratio] HR 5.1, 95% CI 2.23-11.61, p < 0.001) and MUD (HR 3.21, 95% CI 1.48-0.6.94, p = 0.003). Furthermore, both Haplo and MUD were associated with inferior OS, (HR 3.6, 95% CI 1.98-0.6.56, p < 0.001, and HR 2.3, 95% CI 1.37-0.3.88, p = 0.002, respectively), and LFS (HR 2.24, 95% CI 1.31-0.3.84, p = 0.003, and HR 1.64, 95% CI 1.04-0.2.60, p = 0.034, respectively). Patients transplanted from Haplo donors were also associated with worse GFRS (HR 1.72, 95% CI 1.07-2.77, p:0.025) compared with MSD patients. Older adult AML patients with active disease transplanted from MSD experienced prolonged OS and LFS compared to 10/10 MUD and Haplo due to lower NRM. Prospective clinical trials are warranted.

Details

Original languageEnglish
Pages (from-to)983-990
Number of pages8
JournalBone marrow transplantation
Volume59
Issue number7
Publication statusPublished - Jul 2024
Peer-reviewedYes

External IDs

Scopus 85189033763

Keywords

Keywords

  • Humans, Hematopoietic Stem Cell Transplantation/methods, Leukemia, Myeloid, Acute/therapy, Aged, Male, Female, Retrospective Studies, Transplantation, Homologous/methods, Europe, Unrelated Donors, Survival Rate, Disease-Free Survival