T-cell-replete haploidentical transplantation versus autologous stem cell transplantation in adult acute leukemia: a matched pair analysis

Fecha de publicación: 01/04/2015

Autores de IIS La Fe

Miguel Ángel Sanz Alonso

Autor

Participantes ajenos a IIS La Fe

Gorin NC
Labopin M
Piemontese S
Arcese W
Santarone S
Huang H
Meloni G
Ferrara F
Beelen D
Bacigalupo A
Ciceri F
Mailhol A
Nagler A
Mohty M
Acute Leukemia Working Party of the European Society for Blood and Marrow Transp

Grupos

Hematología y Hemoterapia

Investigador Principal

Javier De La Rubia Comos

Abstract

Adult patients with acute leukemia in need of a transplant but without a genoidentical donor are usually considered upfront for transplantation with stem cells from any other allogeneic source, rather than autologous stem cell transplantation. We used data from the European Society for Blood and Marrow Transplantation and performed a matched pair analysis on 188 T-cell-replete haploidentical and 356 autologous transplants done from January 2007 to December 2012, using age, diagnosis, disease status, cytogenetics, and interval from diagnosis to transplant as matching factors. "Haploidentical expert" centers were defined as having reported more than five haploidentical transplants for acute leukemia (median value for the study period). The median follow-up was 28 months. Multivariate analyses, including type of transplant categorized into three classes ("haploidentical regular", "haploidentical expert" and autologous), conditioning intensity (reduced intensity versus myeloablative conditioning) and the random effect taking into account associations related to matching, showed that non-relapse mortality was higher following haploidentical transplants in expert (HR: 4.7; P=0.00004) and regular (HR: 8.98; P<10(-5)) centers. Relapse incidence for haploidentical transplants was lower in expert centers (HR: 0.39; P=0.0003) but in regular centers was similar to that for autologous transplants. Leukemia-free survival and overall survival rates were higher following autologous transplantation than haploidentical transplants in regular centers (HR: 1.63; P=0.008 and HR: 2.31; P=0.0002 respectively) but similar to those following haploidentical transplants in expert centers. We conclude that autologous stem cell transplantation should presently be considered as a possible alternative to haploidentical transplantation in regular centers that have not developed a specific expert program.

Datos de la publicación

ISSN/ISSNe:: 0390-6078, 1592-8721
Tipo:: Article
Páginas:: 561-215
DOI:: 10.3324/haematol.2014.111450
Factor de Impacto:: 2,959 SCImago ℠
Cuartil:: Q1 SCImago ℠

Documentos

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Métricas

Filiaciones

Gorin NC:: APHP, Acute Leukemia Working Party-EBMT and Department of Hematology and Cell Therapy, Höpital Saint-Antoine, Paris, France Sorbonne Universités, UPMC University Paris 06, France INSERM UMR-S 938, Paris, France
Piemontese S:: APHP, Acute Leukemia Working Party-EBMT and Department of Hematology and Cell Therapy, Höpital Saint-Antoine, Paris, France Ospedale San Raffaele s.r.l. Via Olgettina 60, Milan, Italy
Arcese W:: Rome Transplant Network, Tor Vergata University of Rome, Stem Cell Transplant Unit, Policlinico Universitario Tor Vergata, Rome, Italy
Santarone S:: Ospedale Civile, Department of Hematology, Fonte Romana 8, Pescara, Italy
Huang H:: First Affiliated Hospital, Zhejiang University, Bone Marrow Transplantation Center, Hangzhou Zhejiang, China
Meloni G:: University La Sapienza, Rome, Italy
Ferrara F:: Cardarelli Hospital, Napoli, Italy
Beelen D:: University Hospital, Dept. of Bone Marrow Transplantation, Essen, Germany
Sanz M:: Hospital Universitario La Fe, University of Valencia, Spain
Bacigalupo A:: Ospedale San Martino, Department of Haematology II, Genova, Italy
Ciceri F:: Ospedale San Raffaele s.r.l. Via Olgettina 60, Milan, Italy
Mailhol A:: APHP, Acute Leukemia Working Party-EBMT and Department of Hematology and Cell Therapy, Höpital Saint-Antoine, Paris, France
Nagler A:: Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Israel

Campos de estudio

Proyectos asociados

RED DE INVESTIGACION COOPERATIVA DE CANCER

RD06/0020/0031 . INSTITUTO DE SALUD CARLOS III; FUNDACIÓN PARA LA INVESTIGACIÓN DEL HOSPITAL UNIVERSITARIO LA FE DE LA COMUNIDAD VALENCIANA . 2006

PROYECTO CAIBER

CAI08/01/0061 . INSTITUTO DE SALUD CARLOS III; FUNDACIÓN PARA LA INVESTIGACIÓN DEL HOSPITAL UNIVERSITARIO LA FE DE LA COMUNIDAD VALENCIANA . 2009

CREACION Y MEJORA DE INFRAESTRUCTURAS EN MEDICINA REGENERATIVA

Investigador Principal: FUNDACIÓN PARA LA INVESTIGACIÓN DEL HOSPITAL UNIVERSITARIO LA FE DE LA COMUNIDAD VALENCIANA

PLE2009-0141 ACI-PLAN E . MINISTERIO DE CIENCIA E INNOVACION; FUNDACIÓN PARA LA INVESTIGACIÓN DEL HOSPITAL UNIVERSITARIO LA FE DE LA COMUNIDAD VALENCIANA . 2009