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Comparable outcome after haploidentical and HLA-matched allogeneic stem cell transplantation for high-risk acute myeloid leukemia following sequential conditioning—a matched pair analysis

  • Maximilian DoppelhammerEmail author
  • Alessia Fraccaroli
  • Dusan Prevalsek
  • Veit Bücklein
  • Sarah Häbe
  • Christoph Schulz
  • Max Hubmann
  • Andreas Hausmann
  • Rainer Claus
  • Andreas Rank
  • Christoph Schmid
  • Johanna Tischer
Original Article

Abstract

In acute myeloid leukemia (AML), primary refractory or relapsed disease, secondary AML, and leukemia with unfavorable genetics are considered high-risk AML (hrAML), with allogeneic stem cell transplantation (SCT) representing the standard treatment. Sequential conditioning has been successfully used for SCT in hrAML in HLA-matched transplants, and found its way into HLA-haploidentical SCT (haplo-SCT) later on. Hence, sequential conditioning had become standard for all patients with hrAML in our two centers, regardless of donor type. Thereby, HLA-matched family or unrelated transplants were first/second choice, post-transplant cyclophosphamide (PTCY)-based haplo-SCT was chosen in patients missing matched donors or requiring urgent transplantation. To compare the outcome after HLA-matched and haplo-SCT for hrAML following sequential conditioning, we performed a retrospective, matched-pair comparison, using disease stage, genetic subgroups and age as matching criteria. Thirty-four well-matched pairs were identified. At SCT, patients (median age 54 years) were untreated (9%), had remission (13%), or active disease (78%). Three-year overall and leukemia-free survival (OS/LFS) of the entire cohort was 56 ± 7%/49 ± 7%, without significant differences between donor types (OS after HLA-matched/haplo-SCT 62 ± 10%/52 ± 9% (p = 0.21), LFS 53 ± 10%/46 ± 9% (p = 0.26)). Similarly, the cumulative incidence of relapse, non-relapse-mortality and chronic GvHD, as well as GvHD-free, relapse-free survival (GRFS), and chronic GvHD-free, relapse-free survival (cGRFS), were comparable. However, a higher incidence of acute GvHD ≥ II° was observed after HLA-matched SCT (15 ± 1% versus 50 ± 2%, p = 0.001). In conclusion, sequential conditioning SCT achieved remarkable results in hrAML, independently from donor type. PTCY-based haplo-SCT produced results that were comparable to HLA-matched SCT and can be used as an alternative option.

Keywords

AML High-risk AML Haploidentical stem cell transplantation Sequential conditioning FLAMSA-RIC 

Notes

Acknowledgements

The authors wish to acknowledge the dedicated work of our nurses in both transplant units, as well as an excellent data management by M. Rothmayer, A. Bader, and D. Engels.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing financial interests.

Supplementary material

277_2019_3593_MOESM1_ESM.xlsx (12 kb)
ESM 1 (XLSX 12 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Maximilian Doppelhammer
    • 1
    Email author return OK on get
  • Alessia Fraccaroli
    • 2
  • Dusan Prevalsek
    • 2
  • Veit Bücklein
    • 2
  • Sarah Häbe
    • 2
  • Christoph Schulz
    • 2
  • Max Hubmann
    • 2
    • 3
  • Andreas Hausmann
    • 2
    • 4
  • Rainer Claus
    • 1
  • Andreas Rank
    • 1
  • Christoph Schmid
    • 1
  • Johanna Tischer
    • 2
  1. 1.Department of Medicine II, Stem Cell Transplantation Unit, Klinikum AugsburgLudwig-Maximilians University MunichMunichGermany
  2. 2.Department of Medicine III, Stem Cell Transplantation Unit, University HospitalLudwig-Maximilians University MunichMunichGermany
  3. 3.Praxis für Hämatologie und OnkologieHerrschingGermany
  4. 4.Department of Hematology and OncologyKlinikum SchwabingMunichGermany

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