Haploidentical Transplantation for Older Patients with Acute Myeloid Leukemia and Myelodysplastic Syndrome

Stefan O. Ciurea, Mithun V. Shah, Rima M. Saliba, Sameh Gaballa, Piyanuch Kongtim, Gabriela Rondon, Julianne Chen, Whitney Wallis, Kai Cao, Marina Konopleva, Naval Daver, Jorge Cortes, Farhad Ravandi, Amin Alousi, Sairah Ahmed, Uday Popat, Simrit Parmar, Qaiser Bashir, Oran Betul, Chitra HosingElizabeth J. Shpall, Katayoun Rezvani, Issa F. Khouri, Partow Kebriaei, Richard E. Champlin

Research output: Contribution to journalArticle

20 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1232-1236
Number of pages5
JournalBiology of Blood and Marrow Transplantation
Volume24
Issue number6
DOIs
StatePublished - Jun 2018
Externally publishedYes

Keywords

  • Acute myeloid leukemia (AML)
  • Elderly patients
  • Haploidentical stem cell transplant
  • Myelodysplastic syndrome (MDS)
  • Post-transplant cyclophosphamide

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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    Ciurea, S. O., Shah, M. V., Saliba, R. M., Gaballa, S., Kongtim, P., Rondon, G., Chen, J., Wallis, W., Cao, K., Konopleva, M., Daver, N., Cortes, J., Ravandi, F., Alousi, A., Ahmed, S., Popat, U., Parmar, S., Bashir, Q., Betul, O., ... Champlin, R. E. (2018). Haploidentical Transplantation for Older Patients with Acute Myeloid Leukemia and Myelodysplastic Syndrome. Biology of Blood and Marrow Transplantation, 24(6), 1232-1236. https://doi.org/10.1016/j.bbmt.2017.09.005