Haploidentical transplantation is associated with better overall survival when compared to single cord blood transplantation: an EBMT-Eurocord study of acute leukemia patients conditioned with thiotepa, busulfan, and fludarabine - Aix-Marseille Université Access content directly
Journal Articles Journal of Hematology and Oncology Year : 2018

Haploidentical transplantation is associated with better overall survival when compared to single cord blood transplantation: an EBMT-Eurocord study of acute leukemia patients conditioned with thiotepa, busulfan, and fludarabine

Federica Giannotti
  • Function : Author
Myriam Labopin
Roni Shouval
  • Function : Author
Jaime Sanz
William Arcese
Emanuele Angelucci
Jorge Sierra
  • Function : Author
Josep-Maria Ribera Santasusana
  • Function : Author
Stella Santarone
  • Function : Author
Bruno Benedetto
  • Function : Author
Alessandro Rambaldi
Riccardo Saccardi
  • Function : Author
Michele Angelo Carella
  • Function : Author
Vanderson Rocha
  • Function : Author
Frederic Baron
Mohamad Mohty
Annalisa Ruggeri
Arnon Nagler

Abstract

Background: Thiotepa-busulfan-fludarabine (TBF) is a widely used conditioning regimen in single umbilical cord blood transplantation (SUCBT). More recently, it was introduced in the setting of non-T cell depleted haploidentical stem cell transplantation (NTD-Haplo). Whether TBF based conditioning provides additional benefit in transplantation from a particular alternative donor type remains to be established. Methods: This was a retrospective study based on an international European registry. We compared outcomes of de-novo acute myeloid leukemia patients in complete remission receiving NTD-Haplo (n = 186) vs. SUCBT (n = 147) following myeloablative conditioning (MAC) with TBF. Median follow-up was 23 months. Treatment groups resembled in baseline characteristics. Results: SUCBT was associated with delayed engraftment and higher graft failure. In multivariate analysis no statistically significant differences were observed between the two groups in terms of acute or chronic graft-versus-host disease (GvHD) (HR = 1.03, p = 0.92 or HR = 1.86, p = 0.21) and relapse incidence (HR = 0.8, p = 0.65). Non-relapse mortality (NRM) was significantly higher in SUCBT as compared to NTD-Haplo (HR = 2.63, p = 0.001); moreover, SUCBT did worse in terms of overall survival (HR = 2.18, p = 0.002), leukemia-free survival (HR = 1.94, p = 0.007), and GvHD relapse-free survival (HR = 2.38, p = 0.0002). Conclusions: Our results suggest that TBF-MAC might allow for a potent graft-versus-leukemia, regardless of the alternative donor type. Furthermore, in patients receiving TBF-MAC, survival with NTD-Haplo may be better compared to SUCBT due to decreased NRM.

Dates and versions

hal-02143659 , version 1 (29-05-2019)

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Federica Giannotti, Myriam Labopin, Roni Shouval, Jaime Sanz, William Arcese, et al.. Haploidentical transplantation is associated with better overall survival when compared to single cord blood transplantation: an EBMT-Eurocord study of acute leukemia patients conditioned with thiotepa, busulfan, and fludarabine. Journal of Hematology and Oncology, 2018, 11, ⟨10.1186/s13045-018-0655-8⟩. ⟨hal-02143659⟩

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