Older matched sibling donor vs young haploidentical donor for older patients with acute myeloid leukemia

Selection of a suitable donor for allogeneic hematopoietic stem cell transplantation (allo-HCT) has mainly relied on HLA matching and, to date, a matched sibling donor (MSD) remains the first choice. However, patients with acute myeloid leukemia (AML) are older and therefore tend to have older siblings. Haploidentical donors (HIDs) are easily available, and offspring are younger than siblings. As donor age has been associated with worse outcomes, a younger HID might be a better choice than an older MSD for older patients with AML who receive transplantation in first complete remission (CR1). From the European Society for Blood and Marrow Transplantation registry database, we selected patients with AML aged ≥60 years who received transplantation in CR1, either from MSD aged ≥50 years or HID ≤40 years. HIDs received posttransplant cyclophosphamide as graft-versus-host disease (GVHD) prophylaxis, and MSDs received in vivo T-cell depletion. A total of 1247 patients were identified, including 721 MSDs and 526 HIDs. In univariate analysis, HID was associated with lower relapse incidence (P = .01), higher nonrelapse mortality (NRM; P = .01). The 2-year probability of overall survival (OS), leukemia-free survival (LFS), and GVHD-free and relapse-free survival (GRFS) were 62.5%, 56%, and 47%, respectively for the all population. In multivariate analysis, we confirmed that HID was associated with less relapse but more NRM, which translated into similar OS, LFS, and GRFS. Based on this retrospective study, young HIDs led to less relapse but higher NRM than older MSDs after allo-HCT in an older population with AML in CR1.

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Publication Details

Journal
Blood Advances
Published
2025-07-16
DOI
https://doi.org/10.1182/bloodadvances.2024015582
Citations
3
Primary Topic
Hematopoietic Stem Cell Transplantation
Type
article
Field-Weighted Citation Impact
5.31
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article

Older matched sibling donor vs young haploidentical donor for older patients with acute myeloid leukemia

Caroline Besley, Nicolaus Martin Kröger, Gèrard Socié, Emmanuelle Polge et al.
3 citations
Blood Advances
Hematopoietic Stem Cell Transplantation
5.31
article

Older matched sibling donor vs young haploidentical donor for older patients with acute myeloid leukemia

Caroline Besley, Nicolaus Martin Kröger, Gèrard Socié, Emmanuelle Polge, Mohamad Mohty, Didier Blaise, Fabio Ciceri, Patrice Chevallier, Anne Huynh, Jaime Sanz, Myriam Labopin, Xavier Poiré, Cristina Castilla‐Llorente, Arnon Nagler, Igor Wolfgang Blau, Johan A. Maertens, Simona Piemontese, Édouard Forcade, Stéphanie Nguyen
article en
3 citations

Abstract

Selection of a suitable donor for allogeneic hematopoietic stem cell transplantation (allo-HCT) has mainly relied on HLA matching and, to date, a matched sibling donor (MSD) remains the first choice. However, patients with acute myeloid leukemia (AML) are older and therefore tend to have older siblings. Haploidentical donors (HIDs) are easily available, and offspring are younger than siblings. As donor age has been associated with worse outcomes, a younger HID might be a better choice than an older MSD for older patients with AML who receive transplantation in first complete remission (CR1). From the European Society for Blood and Marrow Transplantation registry database, we selected patients with AML aged ≥60 years who received transplantation in CR1, either from MSD aged ≥50 years or HID ≤40 years. HIDs received posttransplant cyclophosphamide as graft-versus-host disease (GVHD) prophylaxis, and MSDs received in vivo T-cell depletion. A total of 1247 patients were identified, including 721 MSDs and 526 HIDs. In univariate analysis, HID was associated with lower relapse incidence (P = .01), higher nonrelapse mortality (NRM; P = .01). The 2-year probability of overall survival (OS), leukemia-free survival (LFS), and GVHD-free and relapse-free survival (GRFS) were 62.5%, 56%, and 47%, respectively for the all population. In multivariate analysis, we confirmed that HID was associated with less relapse but more NRM, which translated into similar OS, LFS, and GRFS. Based on this retrospective study, young HIDs led to less relapse but higher NRM than older MSDs after allo-HCT in an older population with AML in CR1.

Blood AdvancesVol. 9(20)
Cliniques Universitaires Saint-Luc (BE), Inserm (FR), Universität Hamburg (DE), Université Paris Cité (FR), Sheba Medical Center (IL), Universitair Ziekenhuis Leuven (BE), University Hospitals Bristol NHS Foundation Trust (GB), Institut Gustave Roussy (FR), San Raffaele University of Rome (IT), Hospital Universitari i Politècnic La Fe (ES), Centre Hospitalier Universitaire de Nantes (FR), Sorbonne Université (FR), Institut universitaire du cancer de Toulouse Oncopole (FR), Hôpital Saint-Antoine (FR), University Medical Center Hamburg-Eppendorf (DE), Deutsche Gesellschaft für Hämatologie und Medizinische Onkologie (DE), Hôpital Cardiologique du Haut-Lévêque (FR), Pitié-Salpêtrière Hospital (FR), IRCCS Ospedale San Raffaele (IT), Centre de Recherche Saint-Antoine (FR), Hôpital Saint-Louis (FR), Institut Paoli-Calmettes (FR), Istituti di Ricovero e Cura a Carattere Scientifico (IT), Fondation pour la Recherche Médicale (FR), Centro de Investigación Biomédica en Red de Cáncer (ES), European Society for Blood and Marrow Transplantation (FR), Charité - Universitätsmedizin Berlin (DE)
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Hematopoietic Stem Cell Transplantation
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