Graft-versus-Host Disease Prophylaxis with Post- Transplantation Cyclophosphamide in Chronic Myeloid Leukemia Patients Undergoing Allogeneic Hematopoietic Cell Transplantation from an Unrelated or Mismatched Related Donor: A Comparative Study from the Chronic Malignancies Working Party of the EBMT (CMWP-EBMT)
Transplantation and Cellular Therapy, vol. 30, pp. 93.e1–93.e12
Abstract
Outcomes following allogeneic hematopoietic cell transplantation (allo-HCT) for chronic myeloid leukemia (CML) with post-transplantation cyclophosphamide (PTCy) using an unrelated donor (UD) or a mismatched related donor (MMRD) remain unknown. We report a retrospective comparison of PTCy-based allo-HCT from a UD, non-PTCy allo-HCT from a UD, and PTCy allo-HCT from an MMRD. Inclusion criteria were adult patients with CML undergoing first allo-HCT between 2012 and 2019 from a UD with either PTCy or non-PTCy graft-versus-host disease (GVHD) prophylaxis or from an MMRD using PTCy. The primary endpoint was GVHD-free/relapse-free survival (GRFS). A total of 1341 patients were included (82% in the non-PTCy UD cohort). With a median follow-up of 34.9 months, the 3-year GRFS was 43% in the non-PTCy cohort, 37% in the PTCy-UD cohort, and 39% PTCy-MMRD cohort (P = .15). Multivariable analyses revealed no significant differences among the 3 cohorts in terms of overall survival (OS), progression-free survival, RI, and nonrelapse mortality. Factors independently associated with worse OS in the overall cohort were Karnofsky Performance Status <90 (hazard ratio [HR], 1.86; 95% confidence interval [CI], 1.41 to 2.45; P < .001), older age (HR, 1.24, 95% CI, 1.11 to 1.38; P < .001), and disease stage (compared to chronic phase [CP] 1): blast phase (HR, 2.25; 95% CI, 1.60 to 3.16; P < .001), accelerated phase (HR, 1.63; 95% CI, 1.05 to 2.54; P = .03), and CP >2 (HR, 1.58; 95% CI, 1.15 to 2.17; P = .005). These results suggest that allo-HCT in patients with CML using either a UD or an MMRD with PTCy-based GVHD prophylaxis are feasible transplantation, platforms and that the disease stage at allo-HCT remains a major prognostic factor, highlighting the importance of closely monitoring CML patients and proposing transplantation when indicated when still in CP1.
Authors 26
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Guillermo Ortí corresponding
Vall d'Hebron Hospital Universitari · Vall d'Hebron Institute of Oncology
Affiliation as printed
Department of Hematology, Vall d`Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain. Electronic address: gorti@vhio.net
Department of Hematology, Vall d`Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
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European Society for Blood and Marrow Transplantation
Affiliation as printed
EBMT Statistical Unit, Leiden, the Netherlands
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European Society for Blood and Marrow Transplantation
Affiliation as printed
EBMT Leiden Study Unit, Leiden, the Netherlands
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First Pavlov State Medical University of St. Petersburg
Affiliation as printed
RM Gorbacheva Research Institute, Pavlov University, Petersburg, Russian Federation
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Affiliation as printed
Nottingham University, Nottingham, United Kingdom
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Affiliation as printed
Imperial College, London, United Kingdom
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Instytut Hematologii i Transfuzjologi
Affiliation as printed
Institute of Hematology and Transfusion Medicine, Warsaw, Poland
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Charité - Universitätsmedizin Berlin
Affiliation as printed
Charité-Universitätsmedizin Berlin, Berlin, Germany
Charité–Universitätsmedizin Berlin, Berlin, Germany
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Universität Hamburg · University Medical Center Hamburg-Eppendorf
Affiliation as printed
University Hospital Eppendorf, Hamburg, Germany
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Affiliation as printed
Vilnius University Hospital, Vilnius, Lithuania
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Affiliation as printed
University Hospital, Uppsala, Sweden
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Affiliation as printed
Northern Centre for Bone Marrow Transplantation, Newcastle Upon Tyne, United Kingdom
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The Christie Hospital · The Christie NHS Foundation Trust
Affiliation as printed
Christie NHS Trust Hospital, Manchester, United Kingdom
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Ospedale Policlinico San Martino
Affiliation as printed
IRCCS Ospedale Policlinico San Martino, Genova, Italy
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Affiliation as printed
Programme de Transplantation & Therapie Cellulaire, Marseille, France
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King Faisal Specialist Hospital & Research Centre
Affiliation as printed
King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
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Instituto de Investigación Biomédica de Salamanca · Centro de Investigación Biomédica en Red de Cáncer
Affiliation as printed
Hematology Department, Hospital Universitario de Salamanca, IBSAL, CIBERONC, Salamanca, Spain
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G. Papanikolaou General Hospital
Affiliation as printed
George Papanicolaou General Hospital, Thessaloniki, Greece
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University of Liège · Centre Hospitalier Universitaire de Liège
Affiliation as printed
University of Liege and CHU of Liege, Liege, Belgium
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Affiliation as printed
Wroclaw Medical University, Wroclaw, Poland
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Azienda Ospedaliera San Camillo-Forlanini
Affiliation as printed
Ospedale S. Camillo-Forlanini, Rome, Italy
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Guy's and St Thomas' NHS Foundation Trust
Affiliation as printed
Guy's and St.Thomas' NHS Foundation Trust, London, United Kingdom
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Trinity College Dublin · St. James's Hospital
Affiliation as printed
St. James's Hospital, Trinity College, Dublin, Ireland
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Affiliation as printed
University College Hospital, London, United Kingdom
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University of Geneva · University of Liège · University Hospital of Geneva · Centre Hospitalier Universitaire de Liège
Affiliation as printed
Hematology Division and Faculty of Medicine, Hôpitaux Universitaires de Genève, University of Geneva, Geneva, Switzerland
University of Liege and CHU of Liege, Liege, Belgium
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Inserm · Université de Lille · Centre Hospitalier Universitaire de Lille · Institute for Translational Research in Inflammation
Affiliation as printed
CHU de Lille, Univ Lille, INSERM U1286, Infinite, 59000, Lille, France
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