Haploidentical transplantation is associated with better overall survival when compared to single cord blood transplantation: an EBMT-Eurocord study of acute leukemia patients conditioned with thiotepa, busulfan, and fludarabine
Abstract Background Thiotepa-busulfan-fludarabine (TBF) is a widely used conditioning regimen in single umbilical cord blood transplantation (SUCBT). More recently, it was introduced in the setting of non-T cell depleted haploidentical stem cell transplantation (NTD-Haplo). Whether TBF based conditi...
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doaj-f82458ba826541f09f5cf80a3cdb3e172020-11-25T01:36:06ZengBMCJournal of Hematology & Oncology1756-87222018-08-0111111010.1186/s13045-018-0655-8Haploidentical transplantation is associated with better overall survival when compared to single cord blood transplantation: an EBMT-Eurocord study of acute leukemia patients conditioned with thiotepa, busulfan, and fludarabineFederica Giannotti0Myriam Labopin1Roni Shouval2Jaime Sanz3William Arcese4Emanuele Angelucci5Jorge Sierra6Josep-Maria Ribera Santasusana7Stella Santarone8Bruno Benedetto9Alessandro Rambaldi10Riccardo Saccardi11Didier Blaise12Michele Angelo Carella13Vanderson Rocha14Frederic Baron15Mohamad Mohty16Annalisa Ruggeri17Arnon Nagler18Department of Hematology and Cell Therapy, Saint-Antoine HospitalDepartment of Hematology and Cell Therapy, Saint-Antoine HospitalDivision of Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv UniversityHospital Universitari y Politecnic La FeRome Transplant Network, ¨Tor Vergata¨ University of Rome, Stem Cell Transplant Unit, Policlinico Universitario Tor VergataHematology and transplant Unit, Ospedale Policlinico San MartinoHematology Department, Hospital Santa Creu i Sant PauICO-Hospital Universitari Germans Trias i Pujol, Josep Carreras Research InstituteOspedale Civile, Dipartimento di Ematologia, Medicina Trasfusionale e BiotecnologieS.S.C.V.D Trapianto di Cellule Staminali A.O.U Citta della Salute e della Scienza di TorinoAzienda Ospedaliera Papa Giovanni XXIII, Hematology and Bone Marrow Transplant UnitAzienda Ospedaliera Universitaria Careggi, Cell Therapy and Transfusion Medicine UnitProgramme de Transplantation&Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli CalmettesIRCCS, Casa Sollievo della Sofferenza, Department of Hemato-Ooncology, Setm Cell Transplant UnitEurocord, Hôpital Saint Louis, Université Paris-DiderotGIGA-I3, University of LiegeDepartment of Hematology and Cell Therapy, Saint-Antoine HospitalDepartment of Hematology and Cell Therapy, Saint-Antoine HospitalAcute Leukemia Working Party EBMT Paris Office, Hospital Saint- AntoineAbstract Background Thiotepa-busulfan-fludarabine (TBF) is a widely used conditioning regimen in single umbilical cord blood transplantation (SUCBT). More recently, it was introduced in the setting of non-T cell depleted haploidentical stem cell transplantation (NTD-Haplo). Whether TBF based conditioning provides additional benefit in transplantation from a particular alternative donor type remains to be established. Methods This was a retrospective study based on an international European registry. We compared outcomes of de-novo acute myeloid leukemia patients in complete remission receiving NTD-Haplo (n = 186) vs. SUCBT (n = 147) following myeloablative conditioning (MAC) with TBF. Median follow-up was 23 months. Treatment groups resembled in baseline characteristics. Results SUCBT was associated with delayed engraftment and higher graft failure. In multivariate analysis no statistically significant differences were observed between the two groups in terms of acute or chronic graft-versus-host disease (GvHD) (HR = 1.03, p = 0.92 or HR = 1.86, p = 0.21) and relapse incidence (HR = 0.8, p = 0.65). Non-relapse mortality (NRM) was significantly higher in SUCBT as compared to NTD-Haplo (HR = 2.63, p = 0.001); moreover, SUCBT did worse in terms of overall survival (HR = 2.18, p = 0.002), leukemia-free survival (HR = 1.94, p = 0.007), and GvHD relapse-free survival (HR = 2.38, p = 0.0002). Conclusions Our results suggest that TBF-MAC might allow for a potent graft-versus-leukemia, regardless of the alternative donor type. Furthermore, in patients receiving TBF-MAC, survival with NTD-Haplo may be better compared to SUCBT due to decreased NRM.http://link.springer.com/article/10.1186/s13045-018-0655-8Acute myeloid leukemiaStem cell transplantationConditioning regimensThiotepa-busulfan-fludarabineHaploidentical stem cell transplantationUmbilical cord blood transplantation |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Federica Giannotti Myriam Labopin Roni Shouval Jaime Sanz William Arcese Emanuele Angelucci Jorge Sierra Josep-Maria Ribera Santasusana Stella Santarone Bruno Benedetto Alessandro Rambaldi Riccardo Saccardi Didier Blaise Michele Angelo Carella Vanderson Rocha Frederic Baron Mohamad Mohty Annalisa Ruggeri Arnon Nagler |
spellingShingle |
Federica Giannotti Myriam Labopin Roni Shouval Jaime Sanz William Arcese Emanuele Angelucci Jorge Sierra Josep-Maria Ribera Santasusana Stella Santarone Bruno Benedetto Alessandro Rambaldi Riccardo Saccardi Didier Blaise Michele Angelo Carella Vanderson Rocha Frederic Baron Mohamad Mohty Annalisa Ruggeri Arnon Nagler Haploidentical transplantation is associated with better overall survival when compared to single cord blood transplantation: an EBMT-Eurocord study of acute leukemia patients conditioned with thiotepa, busulfan, and fludarabine Journal of Hematology & Oncology Acute myeloid leukemia Stem cell transplantation Conditioning regimens Thiotepa-busulfan-fludarabine Haploidentical stem cell transplantation Umbilical cord blood transplantation |
author_facet |
Federica Giannotti Myriam Labopin Roni Shouval Jaime Sanz William Arcese Emanuele Angelucci Jorge Sierra Josep-Maria Ribera Santasusana Stella Santarone Bruno Benedetto Alessandro Rambaldi Riccardo Saccardi Didier Blaise Michele Angelo Carella Vanderson Rocha Frederic Baron Mohamad Mohty Annalisa Ruggeri Arnon Nagler |
author_sort |
Federica Giannotti |
title |
Haploidentical transplantation is associated with better overall survival when compared to single cord blood transplantation: an EBMT-Eurocord study of acute leukemia patients conditioned with thiotepa, busulfan, and fludarabine |
title_short |
Haploidentical transplantation is associated with better overall survival when compared to single cord blood transplantation: an EBMT-Eurocord study of acute leukemia patients conditioned with thiotepa, busulfan, and fludarabine |
title_full |
Haploidentical transplantation is associated with better overall survival when compared to single cord blood transplantation: an EBMT-Eurocord study of acute leukemia patients conditioned with thiotepa, busulfan, and fludarabine |
title_fullStr |
Haploidentical transplantation is associated with better overall survival when compared to single cord blood transplantation: an EBMT-Eurocord study of acute leukemia patients conditioned with thiotepa, busulfan, and fludarabine |
title_full_unstemmed |
Haploidentical transplantation is associated with better overall survival when compared to single cord blood transplantation: an EBMT-Eurocord study of acute leukemia patients conditioned with thiotepa, busulfan, and fludarabine |
title_sort |
haploidentical transplantation is associated with better overall survival when compared to single cord blood transplantation: an ebmt-eurocord study of acute leukemia patients conditioned with thiotepa, busulfan, and fludarabine |
publisher |
BMC |
series |
Journal of Hematology & Oncology |
issn |
1756-8722 |
publishDate |
2018-08-01 |
description |
Abstract Background Thiotepa-busulfan-fludarabine (TBF) is a widely used conditioning regimen in single umbilical cord blood transplantation (SUCBT). More recently, it was introduced in the setting of non-T cell depleted haploidentical stem cell transplantation (NTD-Haplo). Whether TBF based conditioning provides additional benefit in transplantation from a particular alternative donor type remains to be established. Methods This was a retrospective study based on an international European registry. We compared outcomes of de-novo acute myeloid leukemia patients in complete remission receiving NTD-Haplo (n = 186) vs. SUCBT (n = 147) following myeloablative conditioning (MAC) with TBF. Median follow-up was 23 months. Treatment groups resembled in baseline characteristics. Results SUCBT was associated with delayed engraftment and higher graft failure. In multivariate analysis no statistically significant differences were observed between the two groups in terms of acute or chronic graft-versus-host disease (GvHD) (HR = 1.03, p = 0.92 or HR = 1.86, p = 0.21) and relapse incidence (HR = 0.8, p = 0.65). Non-relapse mortality (NRM) was significantly higher in SUCBT as compared to NTD-Haplo (HR = 2.63, p = 0.001); moreover, SUCBT did worse in terms of overall survival (HR = 2.18, p = 0.002), leukemia-free survival (HR = 1.94, p = 0.007), and GvHD relapse-free survival (HR = 2.38, p = 0.0002). Conclusions Our results suggest that TBF-MAC might allow for a potent graft-versus-leukemia, regardless of the alternative donor type. Furthermore, in patients receiving TBF-MAC, survival with NTD-Haplo may be better compared to SUCBT due to decreased NRM. |
topic |
Acute myeloid leukemia Stem cell transplantation Conditioning regimens Thiotepa-busulfan-fludarabine Haploidentical stem cell transplantation Umbilical cord blood transplantation |
url |
http://link.springer.com/article/10.1186/s13045-018-0655-8 |
work_keys_str_mv |
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