Post-transplant cyclophosphamide containing regimens after matched sibling, matched unrelated and haploidentical donor transplants in patients with acute lymphoblastic leukemia in first complete remission, a comparative study of the ALWP of the EBMT

Jaime Sanz, Jacques-Emmanuel Galimard, Myriam Labopin, Boris Afanasyev, Moiseev Ivan Sergeevich, Emanuele Angelucci, Nicolaus Kröger, Yener Koc, Fabio Ciceri, J L Diez-Martin, Mutlu Arat, Simona Sica, Montserrat Rovira, Mahmoud Aljurf, Johanna Tischer, Bipin Savani, Annalisa Ruggeri, Arnon Nagler, Mohamad Mohty, Jaime Sanz, Jacques-Emmanuel Galimard, Myriam Labopin, Boris Afanasyev, Moiseev Ivan Sergeevich, Emanuele Angelucci, Nicolaus Kröger, Yener Koc, Fabio Ciceri, J L Diez-Martin, Mutlu Arat, Simona Sica, Montserrat Rovira, Mahmoud Aljurf, Johanna Tischer, Bipin Savani, Annalisa Ruggeri, Arnon Nagler, Mohamad Mohty

Abstract

Background: There is no information on the impact of donor type in allogeneic hematopoietic stem cell transplantation (HCT) using homogeneous graft-versus-host (GVHD) prophylaxis with post-transplant cyclophosphamide (PTCy) in acute lymphoblastic leukemia (ALL).

Methods: We retrospectively analyzed outcomes of adult patients with ALL in CR1 that had received HCT with PTCy as GVHD prophylaxis from HLA-matched sibling (MSD) (n = 78), matched unrelated (MUD) (n = 94) and haploidentical family (Haplo) (n = 297) donors registered in the EBMT database between 2010 and 2018. The median follow-up period of the entire cohort was 2.2 years.

Results: Median age of patients was 38 years (range 18-76). Compared to MSD and MUD, Haplo patients received peripheral blood less frequently. For Haplo, MUD, and MSD, the cumulative incidence of 100-day acute GVHD grade II-IV and III-IV, and 2-year chronic and extensive chronic GVHD were 32%, 41%, and 34% (p = 0.4); 13%, 15%, and 15% (p = 0.8); 35%, 50%, and 42% (p = 0.01); and 11%, 17%, and 21% (p = 0.2), respectively. At 2 years, the cumulative incidence of relapse and non-relapse mortality was 20%, 20%, and 28% (p = 0.8); and 21%, 18%, and 21% (p = 0.8) for Haplo, MUD, and MSD, respectively. The leukemia-free survival, overall survival and GVHD-free, relapse-free survival for Haplo, MUD, and MSD was 59%, 62%, and 51% (p = 0.8); 66%, 69%, and 62% (p = 0.8); and 46%, 44%, and 35% (p = 0.9), respectively. On multivariable analysis, transplant outcomes did not differ significantly between donor types. TBI-based conditioning was associated with better LFS.

Conclusions: Donor type did not significantly affect transplant outcome in patient with ALL receiving SCT with PTCy.

Trial registration: ClinicalTrials.gov NCT04232241.

Keywords: Acute lymphoblastic leukemia; Allogeneic stem cell transplant; Alternative donor transplants; Haploidentical transplant; Post-transplant cyclophosphamide.

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Cumulative incidence of relapse according to donor type
Fig. 2
Fig. 2
Cumulative incidence of non-relapse mortality according to donor type
Fig. 3
Fig. 3
Probability of leukemia-free survival according to donor type
Fig. 4
Fig. 4
Probability of overall survival according to donor type

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