Haplo Tx with PT-CY vs. 9/10 MUD+ATG in Deutschland, eine DRST-Analyse
Aysenur Arslan (Ulm / DE), Andrea Gantner (Ulm / DE), Sandra Schmeller (Ulm / DE), Jan Beyersmann (Ulm / DE), Nicolaus Kröger (Hamburg / DE), Thomas Schroeder (Essen / DE), Matthias Stelljes (Münster / DE), Zeiser Robert (Freiburg i. Br. / DE), Peter Dreger (Heidelberg / DE), Matthias Eder (Hannover / DE), Igor Wolfgang Blau (Berlin / DE), Johannes Schetelig (Dresden / DE), Arne Brecht (Darmstadt / DE), Andreas Buchert (Marburg / DE), Matthias Edinger (Regensburg / DE), Amelie Schmid-Möglich (Ulm / DE), Elisa Maria Amann (Ulm / DE), Christine Neuchel (Ulm / DE), Joannis Mytilineos (Ulm / DE), Hubert Schrezenmeier (Ulm / DE), Daniel Fürst (Ulm / DE), Elisa Sala (Ulm / DE)
The success of allogeneic stem cell transplantation (allo-HSCT) is highly dependent on the degree of HLA matching between patient and donor. In cases where no perfectly matched family donor is available, the preferred stem cell source is currently a 10/10 matched unrelated donor (MUD). However, if no suitable 10/10 MUD can be found, a 9/10 matched MUD or a haplo-Tx with post-transplant cyclophosphamide (PT-CY) is considered.
In this registry based retrospective study, we compared the outcomes of alloHSCTs from 9/10 MUD with anti-thymocyte globulin (ATG) based regimens (9/10 MUD-ATG) (n=1143) versus PT-CY Haplo-Tx (n=279) in adult patients with myeloid malignancies (AML or MDS), between 2000 and 2020. In order to compare the outcomes of these two groups, cox proportional hazard models and competing risks regression models were used. Primary clinical endpoints were overall survival (OS) and GRFS (aGvHD and relapse-free survival). Secondary clinical endpoints were disease free survival (DFS), non-relapse mortality (NRM), relapse, acute graft versus host disease (aGvHD) grade III-IV and chronic GvHD (cGvHD).
Univariate analysis showed that 5y OS and DFS was lower in the 9/10 MUD-ATG group (37.8% vs. 49.0%, p = 0.009 and 32.9% vs. 38.4%, p = 0.009). 5y NRM (36.8% vs. 29.4%, p=0.054) did not reach statistical significance. There was no significant difference between the two groups regarding GRFS (22.5% vs. 24.7%), relapse (30.3% vs. 32.2%), and 1y grade III-IV aGvHD (16.8% vs. 16.0%). 5y cGvHD, however, was better in the 9/10 MUD group (33.1% vs. 42.6%, p=0.006 respectively). The multivariate analysis did not show differences (OS: HR 1.13, p=0.326; DFS: HR 1.13,p=0.297; NRM: HR 1.11,p=0.528) with the exception of cGvHD (lower risk for 9/10 MUD+ATG: HR 0.74,CI=0.55-0.98,p=0.035).
Our analysis shows that PT-CY Haplo is a suitable alternative to a 9/10 MUD-ATG unrelated donor. The differences between univariate and multivariate analysis can be explained by differences in the cohort structure. Therefore, a controlled prospective trial is warranted.
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