TY - JOUR
T1 - Haploidentical Transplantation for Older Patients with Acute Myeloid Leukemia and Myelodysplastic Syndrome
AU - Ciurea, Stefan O.
AU - Shah, Mithun V.
AU - Saliba, Rima M.
AU - Gaballa, Sameh
AU - Kongtim, Piyanuch
AU - Rondon, Gabriela
AU - Chen, Julianne
AU - Wallis, Whitney
AU - Cao, Kai
AU - Konopleva, Marina
AU - Daver, Naval
AU - Cortes, Jorge
AU - Ravandi, Farhad
AU - Alousi, Amin
AU - Ahmed, Sairah
AU - Popat, Uday
AU - Parmar, Simrit
AU - Bashir, Qaiser
AU - Betul, Oran
AU - Hosing, Chitra
AU - Shpall, Elizabeth J.
AU - Rezvani, Katayoun
AU - Khouri, Issa F.
AU - Kebriaei, Partow
AU - Champlin, Richard E.
N1 - Publisher Copyright:
© 2017 The American Society for Blood and Marrow Transplantation
PY - 2018/6
Y1 - 2018/6
N2 - Allogeneic stem cell transplantation with HLA-matched donors is increasingly used for older patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). It remains unclear if haploidentical stem cell transplantation (haploSCT) is a suitable option for older patients with this disease. We analyzed 43 patients with AML/MDS (median age, 61 years) who underwent a haploSCT at our institution. All patients received a fludarabine-melphalan–based reduced-intensity conditioning regimen and post-transplant cyclophosphamide-based graft-versus-host disease (GVHD) prophylaxis. Except for 1 patient who had early death, the remaining 42 patients (98%) engrafted donor cells. The cumulative incidences of grades II to IV and III to IV acute GVHD at 6 months were 35% and 5%, respectively, and chronic GVHD at 2 years was 9%. After a median follow-up of 19 months, 2-year overall survival, progression-free survival (PFS), and relapse incidence were 42%, 42%, and 24%, respectively. Best PFS (74% at 2 years) was seen in patients with intermediate-/good-risk cytogenetics, in first or second remission (hazard ratio,.4; P =.05), and with a younger donor (≤40 years; hazard ratio,.2; P =.01). In conclusion, these data suggest that haploidentical transplantation is safe and effective for older AML/MDS patients. Disease status, cytogenetics, and younger donor age are predictors for improved survival in older patients receiving a haploidentical transplant.
AB - Allogeneic stem cell transplantation with HLA-matched donors is increasingly used for older patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). It remains unclear if haploidentical stem cell transplantation (haploSCT) is a suitable option for older patients with this disease. We analyzed 43 patients with AML/MDS (median age, 61 years) who underwent a haploSCT at our institution. All patients received a fludarabine-melphalan–based reduced-intensity conditioning regimen and post-transplant cyclophosphamide-based graft-versus-host disease (GVHD) prophylaxis. Except for 1 patient who had early death, the remaining 42 patients (98%) engrafted donor cells. The cumulative incidences of grades II to IV and III to IV acute GVHD at 6 months were 35% and 5%, respectively, and chronic GVHD at 2 years was 9%. After a median follow-up of 19 months, 2-year overall survival, progression-free survival (PFS), and relapse incidence were 42%, 42%, and 24%, respectively. Best PFS (74% at 2 years) was seen in patients with intermediate-/good-risk cytogenetics, in first or second remission (hazard ratio,.4; P =.05), and with a younger donor (≤40 years; hazard ratio,.2; P =.01). In conclusion, these data suggest that haploidentical transplantation is safe and effective for older AML/MDS patients. Disease status, cytogenetics, and younger donor age are predictors for improved survival in older patients receiving a haploidentical transplant.
KW - Acute myeloid leukemia (AML)
KW - Elderly patients
KW - Haploidentical stem cell transplant
KW - Myelodysplastic syndrome (MDS)
KW - Post-transplant cyclophosphamide
UR - http://www.scopus.com/inward/record.url?scp=85030469844&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85030469844&partnerID=8YFLogxK
U2 - 10.1016/j.bbmt.2017.09.005
DO - 10.1016/j.bbmt.2017.09.005
M3 - Article
C2 - 28918304
AN - SCOPUS:85030469844
SN - 1083-8791
VL - 24
SP - 1232
EP - 1236
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 6
ER -