Aysenur Arslan (Ulm/ DE), Svenja Labuhn (Ulm/ DE), Dr. Elisa Sala (Ulm/ DE), Mark Ringhoffer (Karlsruhe/ DE), Prof. Dr. Nicolaus Kröger (Hamburg/ DE), Elisa Amann (Ulm/ DE), Christine Neuchel (Ulm/ DE), Sandra Schmeller (Ulm/ DE), Jan Beyersmann (Ulm/ DE), Joannis Mytilinoes (Ulm/ DE), Prof. Dr. Hubert Schrezenmeier (Ulm/ DE), PD Dr. Daniel Fürst (Ulm/ DE)
Background
Allogeneic stem cell transplantation (alloHSCT) is the best curative treatment modality for many benign or malignant haematological disorders. In the absence of a matched related donor (MRD), matched unrelated donors (MUD) and haploidentical donors (Haplo-SCT) are the most important sources of stem cells. Despite the increasing number of Haplo-SCT in recent years, multicentre real-life data to compare 10/10 MUD transplantations with Haplo-SCT is still limited.
Methods
In this registry based study, we compared the outcomes of alloHSCTs from 10/10 MUD with conventional graft versus host disease (GvHD) prophylaxis (n=10740) versus haploidentical donors using post-transplant cyclophosphamide as a component of the immunosuppressive regimen (n=515) in adult patients with haematological malignancies. These transplantations were performed between 2010 and 2020. Outcomes for overall survival (OS), disease free survival (DFS), acute GvHD/relapse free survival (GRFS), non-relapse mortality (NRM), relapse, as well as acute GvHD (aGvHD) and chronic GvHD (cGvHD) incidences were analysed. Cox proportional hazard models and competing risks regression models were built to compare the outcomes of the groups.
Results
The stem cell source was more often PBSC in the 10/10 MUD group (96% vs. 75.5%) and 81.2% of the patients in 10/10 MUD group had received ATG. 5-year OS and DFS was seen slightly lower in PT-CY Haplo patients compared to 10/10 MUD (42.8% vs. 45.9%, p=0.032; 34.3% vs. 38.4%, p=0.043, retrospectively). 5-year GRFS was significantly worse in PT-CY Haplo patients (22.6% vs. 32.0%, p<0.001). Multivariate analysis was consistent. Additionally, aGvHD grade II-IV and NRM was found to be increased in the PT-CY Haplo group, whereas cGvHD was higher in the 10/10 MUD group. Interestingly when analyzed for severe aGvHD (grades III-IV) no differences were present between both groups. Also, no difference was observed for relapse incidence.
Conclusion
Our findings suggest that 10/10 MUD transplantation in the lack of MRD remains a better alternative than haploidentical transplantations in terms of better OS, DFS, GRFS and lower incidence of NRM and aGVHD.
Offenlegung Interessenkonflikt:
No conflicts of interest are present
Invited talks abstract/summary