HLA-haploidentical hematopoietic cell transplantation (Haplo-HCT) using posttransplantation cyclophosphamide (PT-Cy) has improved donor availability. However, a matched sibling donor (MSD) is still considered the optimal donor. Using the Center for International Blood and Marrow Transplant Research database, we compared outcomes after Haplo-HCT vs MSD in patients with acute myeloid leukemia (AML) in first complete remission (CR1). Data from 1205 adult CR1 AML patients (2008-2015) were analyzed. A total of 336 patients underwent PT-Cy–based Haplo-HCT and 869 underwent MSD using calcineurin inhibitor–based graft-versus-host disease (GVHD) prophylaxis. The Haplo-HCT group included more reduced-intensity conditioning (65% vs 30%) and bone marrow grafts (62% vs 7%), consistent with current practice. In multivariable analysis, Haplo-HCT and MSD groups were not different with regard to overall survival (P 5 .15), leukemia-free survival (P 5 .50), nonrelapse mortality (P 5 .16), relapse (P 5 .90), or grade II-IV acute GVHD (P 5 .98). However, the Haplo-HCT group had a significantly lower rate of chronic GVHD (hazard ratio, 0.38; 95% confidence interval, 0.30-0.48; P, .001). Results of subgroup analyses by conditioning intensity and graft source suggested that the reduced incidence of chronic GVHD in Haplo-HCT is not limited to a specific graft source or conditioning intensity. Center effect and minimal residual disease–donor type interaction were not predictors of outcome. Our results indicate a lower rate of chronic GVHD after PT-Cy–based Haplo-HCT vs MSD using calcineurin inhibitor–based GVHD prophylaxis, but similar other outcomes, in patients with AML in CR1. Haplo-HCT is a viable alternative to MSD in these patients. © 2019 American Society of Hematology. All rights reserved.
Rashidi, Armin; Hamadani, Mehdi; Zhang, Mei-Jie; Wang, Hai-Lin; Abdel-Azim, Hisham; Aljurf, Mahmoud; Assal, Amer; Bajel, Ashish; Bashey, Asad; Battiwalla, Minoo; Beitinjaneh, Amer M.; Bejanyan, Nelli; Bhatt, Vijaya Raj; Bolaños-Meade, Javier; Byrne, Michael; Cahn, Jean-Yves; Cairo, Mitchell; Ciurea, Stefan; Copelan, Edward; Cutler, Corey; Daly, Andrew; Diaz, Miguel-Angel; Farhadfar, Nosha; Gale, Robert P.; Ganguly, Siddhartha; Grunwald, Michael R.; Hahn, Theresa; Hashmi, Shahrukh; Hildebrandt, Gerhard C.; Holland, H. Kent; Hossain, Nasheed; Kanakry, Christopher G; Kharfan-Dabaja, Mohamed A.; Khera, Nandita; Koc, Yener; Lazarus, Hillard M.; Lee, Jong-Wook; Maertens, Johan; Martino, Rodrigo; McGuirk, Joseph; Munker, Reinhold; Murthy, Hemant S.; Nakamura, Ryotaro; Nathan, Sunita; Nishihori, Taiga; Palmisiano, Neil D.; Patel, Sagar; Pidala, Joseph; Olin, Rebecca; Olsson, Richard F.; Oran, Betul; Ringden, Olov; Rizzieri, David; Rowe, Jacob; Savoie, Mary Lynn; Schultz, Kirk R.; Seo, Sachiko; Shaffer, Brian C.; Singh, Anurag; Solh, Melhem; Stockerl-Goldstein, Keith; Verdonck, Leo F.; Wagner, John; Waller, Edmund K.; De Lima, Marcos; Sandmaier, Brenda M.; Litzow, Mark; Weisdorf, Dan; Romee, Rizwan; and Saber, Wael, "Outcomes of haploidentical vs matched sibling transplantation for acute myeloid leukemia in first complete remission." (2019). Department of Medical Oncology Faculty Papers. Paper 95.