Impact of donor kinship on non-T-cell depleted haploidentical stem cell transplantation with post transplantation cyclophosphamide for acute leukemia: From the ALWP of the EBMT

• Published in: Bone marrow transplantation (Basingstoke) 2022-08, Vol.57 (8), p.1260-1268
• Main Authors: Danylesko, Ivetta, Peczynski, Christophe, Labopin, Myriam, Polge, Emmanuelle, Tischer, Johanna, Blaise, Didier, Koc, Yener, Gülbas, Zafer, Ciceri, Fabio, Arat, Mutlu, Castagna, Luca, Bruno, Benedetto, Raiola, Anna Maria, Botella-Garcia, Carmen, Savani, Bipin N., Piemontese, Simona, Ruggeri, Annalisa, Nagler, Arnon, Mohty, Mohamad
• Format: Article
• Language: English
• Subjects: 692/308/2171; 692/699/1541/1990/283; 692/700; Cell Biology; Children; Cyclophosphamide; Depletion; Donors; Graft-versus-host reaction; Hematology; Hematopoietic stem cells; Internal Medicine; Leukemia; Lymphatic leukemia; Lymphocytes T; Medical prognosis; Medicine; Medicine & Public Health; Multivariate analysis; Parents; Peripheral blood; Public Health; Siblings; Stem cell transplantation; Stem Cells; Survival; Transplantation; Transplants & implants
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/s41409-022-01695-6

Non-T-cell depleted haploidentical hematopoietic cell transplantation (Haplo-HCT) is a unique transplantation setting in which several donors are available. We assessed the impact of donor kinship on outcome of Haplo-HCT with post-transplantation cyclophosphamide in a cohort of 717 acute leukemia patients. We compared sibling with parent donors in patients ≤45 years, and child with sibling donors in patients >45 years. Donor kinship was not associated with worse outcomes in multivariate analysis. For patients ≤45 years, the hazard ratio (HR) for leukemia-free survival (LFS), overall survival (OS), relapse incidence (RI), and chronic graft-versus-host disease (cGVHD) was 0.87 ( p  = 0.75), 1.19 ( p  = 0.7), 0.52 ( p  = 0.19), and 0.99 ( p  = 0.97) for parents versus siblings, respectively, and for patients >45 years the HR was 0.93 ( p  = 0.8), 0.98 ( p  = 0.94), 1.3 ( p  = 0.53), and 0.98 ( p  = 0.95) for children versus siblings, respectively. Univariate incidence of acute GVHD grade II-IV was significantly higher in patients transplanted from siblings versus children ( p  = 0.002). Factors associated with inferior outcome were advanced disease and earlier transplant. In patients ≤45 years, acute lymphocytic leukemia and peripheral blood stem cell graft were additional prognostic factors for OS. We did not find a significant impact of donor kinship on transplantation outcome when analyzing by age group (≤45 and >45 years).