PMID- 37688521 OWN - NLM STAT- MEDLINE DCOM- 20231116 LR - 20231207 IS - 1096-8652 (Electronic) IS - 0361-8609 (Print) IS - 0361-8609 (Linking) VI - 98 IP - 12 DP - 2023 Dec TI - Prospective analysis to determine barriers to allogeneic hematopoietic cell transplantation in patients with acute leukemia. PG - 1869-1876 LID - 10.1002/ajh.27084 [doi] AB - Allogeneic hematopoietic cell transplantation (allo-HCT) is a potentially curative treatment for patients with acute leukemia. Despite this, studies have shown that only a minority of patients ultimately proceed to allo-HCT. The primary objective of this prospective, observational study was to identify the rate of allo-HCT in patients for whom it was recommended, and reasons why patients deemed appropriate and eligible for HCT did not subsequently undergo transplant. Between April 2016 and April 2021, adult patients with newly diagnosed or relapsed/refractory acute leukemia were enrolled at the time of induction/reinduction therapy. Initial transplantation workup and allo-HCT recommendations were made during the early phase of induction/reinduction. Of the 307 enrolled patients, allo-HCT was recommended to 85% (n = 259), of whom 66% (n = 170) underwent transplant. Donor sources comprised 54% human leukocyte antigen (HLA)-matched unrelated donors, 20% HLA-matched sibling donors and HLA-mismatched graft sources with 15% umbilical cord blood units, 8% HLA-mismatched unrelated donors, and 4% HLA-haploidentical donors. The most common reason for transplant disqualification in the 89 patients in whom it was initially recommended was persistent/relapsed disease (70%), followed by early patient death (10%). In this prospective study, we report a high allo-HCT rate, which may be due to early transplant referral and workup. The main allo-HCT barrier was disease control, followed by early patient death. With the increasing availability of HLA-mismatched graft sources, the lack of donor availability was not a transplant barrier. Further development of novel transplant strategies for patients not achieving remission and improvements in induction regimens could result in increased allo-HCT utilization. CI - (c) 2023 Wiley Periodicals LLC. FAU - Nath, Karthik AU - Nath K AUID- ORCID: 0000-0002-3881-5681 AD - Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA. FAU - Lee, Jasme AU - Lee J AD - Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA. FAU - Elko, Theresa A AU - Elko TA AD - Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA. FAU - Levy, Lauren AU - Levy L AD - Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA. FAU - Preston, Elaina AU - Preston E AD - Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA. FAU - Devlin, Sean M AU - Devlin SM AD - Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA. FAU - Ponce, Doris M AU - Ponce DM AD - Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA. AD - Department of Medicine, Weill Cornell Medical College, New York, New York, USA. FAU - Lin, Richard J AU - Lin RJ AD - Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA. AD - Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA. AD - Department of Medicine, Weill Cornell Medical College, New York, New York, USA. FAU - Shaffer, Brian C AU - Shaffer BC AD - Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA. AD - Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA. AD - Department of Medicine, Weill Cornell Medical College, New York, New York, USA. FAU - Cho, Christina AU - Cho C AD - Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA. AD - Department of Medicine, Weill Cornell Medical College, New York, New York, USA. FAU - Politikos, Ioannis AU - Politikos I AD - Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA. AD - Department of Medicine, Weill Cornell Medical College, New York, New York, USA. FAU - Jakubowski, Ann A AU - Jakubowski AA AD - Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA. AD - Department of Medicine, Weill Cornell Medical College, New York, New York, USA. FAU - Park, Jae H AU - Park JH AD - Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA. AD - Department of Medicine, Weill Cornell Medical College, New York, New York, USA. AD - Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA. FAU - Rampal, Raajit AU - Rampal R AD - Department of Medicine, Weill Cornell Medical College, New York, New York, USA. AD - Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA. FAU - Perales, Miguel-Angel AU - Perales MA AD - Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA. AD - Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA. AD - Department of Medicine, Weill Cornell Medical College, New York, New York, USA. FAU - Tallman, Martin S AU - Tallman MS AD - Department of Medicine, Weill Cornell Medical College, New York, New York, USA. AD - Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA. FAU - Barker, Juliet N AU - Barker JN AD - Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA. AD - Department of Medicine, Weill Cornell Medical College, New York, New York, USA. FAU - Berman, Ellin AU - Berman E AD - Department of Medicine, Weill Cornell Medical College, New York, New York, USA. AD - Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA. FAU - Tamari, Roni AU - Tamari R AD - Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA. AD - Department of Medicine, Weill Cornell Medical College, New York, New York, USA. FAU - Stein, Eytan AU - Stein E AD - Department of Medicine, Weill Cornell Medical College, New York, New York, USA. AD - Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA. FAU - Giralt, Sergio A AU - Giralt SA AD - Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA. AD - Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA. AD - Department of Medicine, Weill Cornell Medical College, New York, New York, USA. FAU - Gyurkocza, Boglarka AU - Gyurkocza B AD - Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA. AD - Department of Medicine, Weill Cornell Medical College, New York, New York, USA. LA - eng GR - P30 CA008748/CA/NCI NIH HHS/United States PT - Journal Article PT - Observational Study PT - Research Support, N.I.H., Extramural DEP - 20230909 PL - United States TA - Am J Hematol JT - American journal of hematology JID - 7610369 RN - 0 (HLA Antigens) SB - IM MH - Adult MH - Humans MH - Prospective Studies MH - *Hematopoietic Stem Cell Transplantation/adverse effects MH - Unrelated Donors MH - Transplantation, Homologous MH - *Leukemia, Myeloid, Acute/therapy/etiology MH - Acute Disease MH - HLA Antigens MH - *Graft vs Host Disease/etiology MH - Retrospective Studies PMC - PMC10697699 MID - NIHMS1927546 EDAT- 2023/09/09 21:42 MHDA- 2023/11/16 06:45 PMCR- 2024/12/01 CRDT- 2023/09/09 08:02 PHST- 2023/08/19 00:00 [received] PHST- 2023/08/23 00:00 [accepted] PHST- 2024/12/01 00:00 [pmc-release] PHST- 2023/11/16 06:45 [medline] PHST- 2023/09/09 21:42 [pubmed] PHST- 2023/09/09 08:02 [entrez] AID - 10.1002/ajh.27084 [doi] PST - ppublish SO - Am J Hematol. 2023 Dec;98(12):1869-1876. doi: 10.1002/ajh.27084. Epub 2023 Sep 9.