Outcome after allogeneic stem cell transplantation with haploidentical versus HLA-matched donors in patients with higher-risk MDS
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Published:2023-02-11
Issue:5
Volume:58
Page:534-543
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ISSN:0268-3369
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Container-title:Bone Marrow Transplantation
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language:en
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Short-container-title:Bone Marrow Transplant
Author:
Michel Claire, Robin MarieORCID, Morisset Stephane, Blaise DidierORCID, Maertens Johan, Chevalier Patrice, Castilla-Llorente Cristina, Forcade EdouardORCID, Ceballos Patrice, Yakoug-Agha IbrahimORCID, Poire XavierORCID, Carre Martin, Bay Jacques-Olivier, Beguin Yves, Loschi MichaelORCID, Huynh Anne, Guillerm Gaëlle, François Sylvie, Mear Jean-Baptiste, Duléry RémyORCID, Suarez Felipe, Bilger Karin, Cornillon JérômeORCID, Chalandon YvesORCID, Maillard Natacha, Labussière-Wallet Hélène, Charbonnier Amandine, Turlure Pascal, Berceanu Ana, Chantepie Sylvain, Maury Sébastien, Bazarbachi AliORCID, Menard Anne-Lise, Nguyen-Quoc Stephanie, Rubio Marie-Thérèse, D’Aveni MaudORCID
Abstract
AbstractAllogeneic hematopoietic stem cell transplantation remains the best curative option for higher-risk myelodysplastic syndrome. The presence of monosomal karyotype and/or complex karyotype abnormalities predicts inferior survival after allo-SCT in MDS patients. Haploidentical allo-SCT has been increasingly used in acute leukemia (AL) and has similar results as using HLA-matched donors, but data on higher-risk MDS is sparse. We compared outcomes in 266 patients with higher-risk MDS after HLA-matched sibling donor (MSD, n = 79), HLA-matched unrelated donor (MUD, n = 139) and HLA haploidentical donor (HID, n = 48) from 2010 to 2019. Median donor age differed between the three groups (p < 0.001). The overall survival was significantly different between the three groups with a better OS observed in the MUD group (p = 0.014). This observation could be explained by a higher progression-free survival with MUD (p = 0.014). The cumulative incidence of grade 2–4 acute GvHD was significantly higher in the HID group (p = 0.051). However, in multivariable analysis, patients transplanted using an HID had comparable mortality to patients transplanted using a MUD (subdistribution hazard ratio [sHR]: 0.58 [0.32–1.07]; p = 0.080) and a MSD ([sHR]: 0.56 [0.28–1.11]; p = 0.094). MUD do not remain a significant positive predictor of survival, suggesting that beyond the donor-recipient HLA matching, the donor age might impact recipient outcome.
Publisher
Springer Science and Business Media LLC
Subject
Transplantation,Hematology
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