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<p>We evaluated the influence of donor type in 3006 adults with adverse-risk cytogenetic acute myeloid leukemia (AML) in first complete remission undergoing allogeneic hematopoietic cell transplantation (HCT). Donor types included matched sibling (MSD), matched unrelated (MUD), mismatched unrelated (MMUD), and haploidentical donors. At 2 years, leukemia-free survival, overall survival (OS), and graft-versus-host disease (GVHD)-free/relapse-free survival were 47%, 55%, and 36%. Compared with MSD, OS was inferior with MUD (HR 1.36; 95% CI, 1.1–1.67), MMUD (HR 1.4; 95% CI, 1.07–1.83), and haploidentical grafts (HR 1.33; 95% CI, 1.02–1.73). Haploidentical was associated with lower relapse risk (HR 0.72; 95% CI, 0.53–0.97), but higher non-relapse mortality (NRM) (HR 3.85; 95% CI, 2.44–6.08). All alternative donors showed higher rates of grade II–IV acute GVHD. In 702 patients receiving post-transplant cyclophosphamide (PTCy), survival differences attenuated. However, haploidentical and MMUD showed higher risk of grade III–IV acute GVHD (HR 2.61; 95% CI, 1.04–6.54 and HR 3.74; 95% CI, 1.14–12.24), and haploidentical had increased NRM (HR 3.22; 95% CI, 1.23–8.44), without significant relapse. Findings support safety of alternative donors and reinforce MSD as preferred choice in adverse-risk AML. PTCy mitigates but does not eliminate the&#xa0;risk of&#xa0;donor mismatch.</p>

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Impact of donor selection in adverse-risk AML undergoing hematopoietic cell transplantation: A study from the EBMT Acute Leukemia Working Party

  • 期刊论文

  • 发表日期：

    2025年11月29日

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  • Marta Villalba,
  • Allain-Thibeault Ferhat,
  • Tobias Gedde-Dahl,
  • Gerard Socie,
  • Anne Huynh,
  • Igor Wolfgang Blau,
  • Ibrahim Yakoub-Agha,
  • Didier Blaise,
  • Matthias Eder,
  • Edouard Forcade,
  • Renato Fanin,
  • Jakob Passweg,
  • Charles Crawley,
  • Matthias Stelljes,
  • Friedrich Stölzel,
  • Nicolaus Kroeger,
  • Henrik Sengeloev,
  • Patrice Ceballos,
  • Helene Labussiere-Wallet,
  • Xavier Poiré,
  • Jordi Esteve,
  • Bipin Savani,
  • Arnon Nagler,
  • Simona Piemontese,
  • Jaime Sanz,
  • Mohamad Mohty,
  • Fabio Ciceri

摘要

We evaluated the influence of donor type in 3006 adults with adverse-risk cytogenetic acute myeloid leukemia (AML) in first complete remission undergoing allogeneic hematopoietic cell transplantation (HCT). Donor types included matched sibling (MSD), matched unrelated (MUD), mismatched unrelated (MMUD), and haploidentical donors. At 2 years, leukemia-free survival, overall survival (OS), and graft-versus-host disease (GVHD)-free/relapse-free survival were 47%, 55%, and 36%. Compared with MSD, OS was inferior with MUD (HR 1.36; 95% CI, 1.1–1.67), MMUD (HR 1.4; 95% CI, 1.07–1.83), and haploidentical grafts (HR 1.33; 95% CI, 1.02–1.73). Haploidentical was associated with lower relapse risk (HR 0.72; 95% CI, 0.53–0.97), but higher non-relapse mortality (NRM) (HR 3.85; 95% CI, 2.44–6.08). All alternative donors showed higher rates of grade II–IV acute GVHD. In 702 patients receiving post-transplant cyclophosphamide (PTCy), survival differences attenuated. However, haploidentical and MMUD showed higher risk of grade III–IV acute GVHD (HR 2.61; 95% CI, 1.04–6.54 and HR 3.74; 95% CI, 1.14–12.24), and haploidentical had increased NRM (HR 3.22; 95% CI, 1.23–8.44), without significant relapse. Findings support safety of alternative donors and reinforce MSD as preferred choice in adverse-risk AML. PTCy mitigates but does not eliminate the risk of donor mismatch.