PMID- 29469924 OWN - NLM STAT- MEDLINE DCOM- 20190911 LR - 20190911 IS - 1097-0142 (Electronic) IS - 0008-543X (Linking) VI - 124 IP - 10 DP - 2018 May 15 TI - T-cell-depleted haploidentical stem cell transplantation results improve with time in adults with acute leukemia: A study from the Acute Leukemia Working Party of the European Society of Blood and Marrow Transplantation (EBMT). PG - 2142-2150 LID - 10.1002/cncr.31310 [doi] AB - BACKGROUND: T-cell-depleted, haploidentical transplantations (haplos) are commonly offered to patients who have high-risk, acute leukemia in the absence of a human leukocyte antigen (HLA) full-matched donor. METHODS: To determine the effect of transplantation period, the authors divided 308 adults with de novo, acute leukemia who underwent T-cell-depleted haplo from 2005 to 2015 into 2 groups, according the year in which they underwent transplantation (2005-2011 [n = 191] and 2012-2015 [n = 117]). RESULTS: The median age was 41 years in patients who underwent transplantation before 2012 and 46 years in those who underwent transplantation after 2012 (P = .04). Most patients had acute myeloid leukemia (75% vs 69%; P = .26) and were in first complete remission (CR1) (55% vs 64%; P = .12) at the time of transplantation. The cumulative incidence of grade 2, 3, and 4 acute graft-versus-host disease (GvHD) and chronic GvHD were not different between the 2 groups (acute GvHD: 20% vs 22% cumulative incidence in patients who underwent haplo before and after 2012, respectively [P = .67]; chronic GvHD: 19% vs 11% cumulative incidence, respectively; P = .12]. The 2-year relapse incidence was 20%, the nonrelapse mortality (NRM) rate was 48%, and no difference was observed over time (21% vs 19% [P = .72] and 54% vs 38% [P = .11] for patients who underwent haplo before and after 2012, respectively). The main cause of NRM was infection. Haplo after 2012 (hazard ratio [HR], 0.57; P = .01), younger age (HR, 0.82; P = .02), and receipt of a reduced-intensity conditioning (RIC) regimen (HR, 0.53; P = .01) were independently associated with lower NRM. The 2-year overall survival rate was 36% and improved after 2012 (29% vs 47% before 2012; P = .02); and it was higher for patients who underwent transplantation in CR1 (41% vs 29%; P = .01). In multivariate analysis, haplo after 2012 (HR, 0.54; P = .003) and receipt of a RIC regimen (HR, 0.54; P = .005) were independently associated with better overall survival. Similarly, leukemia-free survival and GvHD-free/relapse-free survival (GRFS) improved over time: the leukemia-free survival rate was 31% (25% vs 43% in the groups who underwent transplantation before and after 2012, respectively; P = .05), and the GRFS rate was 24% (19% vs 34%, respectively; P = .09). In addition, leukemia-free survival and GRFS improved among patients who received a RIC regimen. CONCLUSIONS: The outcome of patients with acute leukemia who underwent T-cell-depleted haplo has improved over time. Cancer 2018;124:2142-50. (c) 2018 American Cancer Society. CI - (c) 2018 American Cancer Society. FAU - Sestili, Simona AU - Sestili S AUID- ORCID: 0000-0003-4083-6972 AD - Hematology Clinic and Cellular Therapy, St. Antoine Hospital, Public Assistance Hospitals of Paris (AP-HP), Paris, France. FAU - Labopin, Myriam AU - Labopin M AD - European Society of Blood and Marrow Transplantation Paris Office, St. Antoine Hospital, Paris, France. FAU - Ruggeri, Annalisa AU - Ruggeri A AUID- ORCID: 0000-0002-7261-2765 AD - Hematology Clinic and Cellular Therapy, St. Antoine Hospital, Public Assistance Hospitals of Paris (AP-HP), Paris, France. AD - European Society of Blood and Marrow Transplantation Paris Office, St. Antoine Hospital, Paris, France. AD - Eurocord, St. Louis Hospital AP-HP and University Institute of Hematology Paris VII, Paris, France. FAU - Velardi, Andrea AU - Velardi A AD - Hematology Section, Department of Clinical and Experimental Medicine, University of Perugia, Santa Maria della Perugia Hospital, Perugia, Italy. FAU - Ciceri, Fabio AU - Ciceri F AD - Department of Hematology and Bone Marrow Transplantation, Institute for Research and Health Care, San Raffaele Hospital, Milan, Italy. FAU - Maertens, Johan AU - Maertens J AD - Department of Hematology, Gasthuisberg University Hospital, Leuven, Belgium. FAU - Kanz, Lothar AU - Kanz L AD - Medical Clinic, Tubingen University, Tubingen, Germany. FAU - Aversa, Franco AU - Aversa F AD - Hematology Unit, Bone Marrow Transplant Center, University of Parma, Parma, Italy. FAU - Lewalle, Philippe AU - Lewalle P AD - Department of Hematology and Transplantation, Jules Bordet Institute, Brussels, Belgium. FAU - Bunjes, Donald AU - Bunjes D AD - Third Clinic of Internal Medicine, Ulm University Clinic, Ulm, Germany. FAU - Mohty, Mohamad AU - Mohty M AD - Hematology Clinic and Cellular Therapy, St. Antoine Hospital, Public Assistance Hospitals of Paris (AP-HP), Paris, France. AD - European Society of Blood and Marrow Transplantation Paris Office, St. Antoine Hospital, Paris, France. FAU - Nagler, Arnon AU - Nagler A AD - European Society of Blood and Marrow Transplantation Paris Office, St. Antoine Hospital, Paris, France. AD - Division of Hematology and Bone Marrow Transplantation, the Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel. LA - eng PT - Journal Article DEP - 20180222 PL - United States TA - Cancer JT - Cancer JID - 0374236 SB - IM MH - Adult MH - Disease-Free Survival MH - Female MH - Follow-Up Studies MH - Graft vs Host Disease/immunology/prevention & control MH - Hematopoietic Stem Cell Transplantation/adverse effects/*methods/trends MH - Humans MH - Incidence MH - Leukemia, Myeloid, Acute/mortality/*therapy MH - Lymphocyte Depletion/adverse effects/*methods MH - Male MH - Middle Aged MH - Mortality/*trends MH - Neoplasm Recurrence, Local/*epidemiology/prevention & control MH - Remission Induction/methods MH - Survival Rate MH - T-Lymphocytes/immunology MH - Time Factors MH - Transplantation Conditioning/methods MH - Transplantation, Haploidentical/adverse effects/*methods/trends MH - Young Adult OTO - NOTNLM OT - T-cell depletion OT - acute leukemia OT - haploidentical transplantation OT - outcomes OT - time EDAT- 2018/02/23 06:00 MHDA- 2019/09/12 06:00 CRDT- 2018/02/23 06:00 PHST- 2017/10/30 00:00 [received] PHST- 2017/12/19 00:00 [revised] PHST- 2018/01/17 00:00 [accepted] PHST- 2018/02/23 06:00 [pubmed] PHST- 2019/09/12 06:00 [medline] PHST- 2018/02/23 06:00 [entrez] AID - 10.1002/cncr.31310 [doi] PST - ppublish SO - Cancer. 2018 May 15;124(10):2142-2150. doi: 10.1002/cncr.31310. Epub 2018 Feb 22.