Work

A comparison of haploidentical versus HLA-identical sibling outpatient hematopoietic cell transplantation using reduced intensity conditioning in patients with acute leukemia

Year: 2024

Type: article

Abstract: Background Hematopoietic cell transplantation (HCT) increases survival for acute leukemia. Outpatient allogeneic HCT reduces costs and increases transplant rates in developing countries. We report outcomes of outpatient HLA-identical and haploidentical HCT in acute leukemia. Methods This single-center retrospective cohort study analyzed 121 adult patients with acute myeloblastic (AML) and acute lymphoblastic leukemia (ALL) receiving an outpatient allogeneic HCT with peripheral blood allografts after reduced-intensity conditioning (RIC) from 2012-2022. Results There were 81 (67%) haploidentical and 40 (33%) HLA-identical transplants. Complete chimerism (CC) at day +100 was not different in HLA-identical compared to haploidentical HCT (32.5% and 38.2%, P =0.054). Post-HCT complications, including neutropenic fever (59.3% vs. 40%), acute graft-versus-host-disease (aGVHD) (46.9% vs. 25%), cytokine release syndrome (CRS) (18.5% vs. 2.5%), and hospitalization (71.6% vs 42.5%) were significantly more frequent in haploidentical HCT. Two-year overall survival (OS) was 60.6% vs. 46.9%, ( P =0.464) for HLA-identical and haplo-HCT, respectively. There was no difference in the 2-year disease-free-survival (DFS) (33.3% vs. 35%, P =0.924) between transplant types. In multivariate analysis, positive measurable residual disease (MRD) at 30 days (HR 8.8, P =0.018) and 100 days (HR 28.5, P =0.022) was associated with lower OS, but not with non-relapse mortality (NRM) ( P =0.252 and P =0.123, univariate). In univariate analysis, both 30-day and 100-day MRD were associated with lower DFS rates ( P =0.026 and P =0.006), but only day 30 MRD was significant in multivariate analysis ( P =0.050). In the case of relapse, only MRD at day 100 was associated with increased risk in the univariate and multivariate analyses (HR 4.48, P =0.003 and HR 4.67, P =0.008). Chronic graft-versus-host-disease (cGVHD) was protective for NRM (HR 0.38, P =0.015). There was no difference in cumulative incidence of relapse (CIR) between transplant types ( P =0.126). Forty-four (36.4%) patients died, with no difference between HCT type ( P =0.307). Septic shock was the most frequent cause of death with 17 cases, with no difference between transplant types Conclusions Outpatient peripheral blood allogenic HCT after RIC is a valid and effective alternative for adult patients suffering acute myeloblastic or lymphoblastic leukemia in low-income populations.

Source: Frontiers in Immunology

DOI: 10.3389/fimmu.2024.1400610