PMID- 38029962 OWN - NLM STAT- MEDLINE DCOM- 20240318 LR - 20240318 IS - 2666-6367 (Electronic) IS - 2666-6367 (Linking) VI - 30 IP - 3 DP - 2024 Mar TI - Peripheral Blood Haploidentical Allogeneic Stem Cell Transplantation in Older Adults with Acute Myeloid Leukemia and Myelodysplastic Syndromes Demonstrates Long Term Survival, Results from Australia and New Zealand Transplant and Cellular Therapies. PG - 334.e1-334.e7 LID - S2666-6367(23)01707-4 [pii] LID - 10.1016/j.jtct.2023.11.018 [doi] AB - There is a limited body of evidence for haploidentical hematopoietic stem cell transplantation (haplo-HSCT) in older patients. Previous studies have used a high proportion of bone marrow-derived grafts and a variety of conditioning regimens. In Australia and New Zealand, haplo-HCST is predominantly performed using peripheral blood (PB) with universal use of post-transplantation cyclophosphamide (PTCy). To characterize the outcomes of older recipients undergoing haplo-HSCT for acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS). Data were collected through the Australasian Bone Marrow Transplant Recipient Registry (ABMTRR) for patients aged 65 or older receiving a PB haplo-HSCT for AML/MDS between January 2010 and July 2020. A total of 44 patients were included in the analysis. The median follow-up time was 377 days. The median age was 68 (range 65-74) with a median Karnofsky performance status of 90. Thirty patients (68.2%) had AML, whereas 14 (31.8%) had MDS. The median donor age was 40. The most common conditioning regimen was nonmyeloablative fludarabine, cyclophosphamide, and total body irradiation (75%); the remainder of the patients received either melphalan- or busulfan-based regimens, and the majority were reduced intensity, with only 2 patients undergoing myeloablative conditioning. All patients received post-transplantation cyclophosphamide and mycophenolate mofetil, with the majority also receiving tacrolimus (90.5%) and the remainder receiving cyclosporine (9.5%). No patients received anti-thymocyte globulin. Neutrophil engraftment was achieved in 97.6% of patients at a median of 18 days, whereas platelet engraftment was achieved in 92.7% of patients at a median of 28 days. The cumulative incidences of cytomegalovirus (CMV) reactivation and CMV disease were 52.5% and 5.1% at 1 year. The incidence of grade 2-4 acute Graft Versus Host Disease (GVHD) was 18.2%. The incidence of chronic GVHD at 2 years was 40.7%, with extensive chronic GVHD occurring in 17.7% of patients. The incidences of relapse and non-relapse mortality (NRM) at 2 years were 8.8% and 20.7% respectively. The leading causes of death were infection (64.7%) followed by relapse (14.2%). The 2-year overall survival was 74%. Relapse free survival and GVHD free, relapse free survival at 2 years was 70% and 48%. Haplo-HSCT using a peripheral blood graft and PTCy GVHD prophylaxis demonstrates long-term disease control with acceptable rates of NRM for older patients with AML/MDS. CI - Crown Copyright (c) 2023. Published by Elsevier Inc. All rights reserved. FAU - Abadir, Edward AU - Abadir E AD - Royal Prince Alfred Hospital, Camperdown, Australia. Electronic address: edward.abadir@health.nsw.gov.au. FAU - Othman, Jad AU - Othman J AD - Royal North Shore Hospital, St Leonards, Australia. FAU - Kwan, John AU - Kwan J AD - Westmead Hospital, Westmead, Australia. FAU - Gottlieb, David J AU - Gottlieb DJ AD - Westmead Hospital, Westmead, Australia. FAU - Kennedy, Glen A AU - Kennedy GA AD - Royal Brisbane and Women's Hospital, Brisbane, Australia. FAU - Bajel, Ashish AU - Bajel A AD - Royal Melbourne Hospital, Parkville, Australia. FAU - Doocey, Richard AU - Doocey R AD - Auckland City Hospital, Auckland, New Zealand. FAU - Perera, Travis AU - Perera T AD - Wellington Blood and Cancer Centre, Wellington, New Zealand. FAU - Watson, Anne-Marie AU - Watson AM AD - Liverpool Hospital, Sydney, Australia. FAU - Bardy, Peter G AU - Bardy PG AD - Royal Adelaide Hospital, Adelaide, Australia. FAU - Greenwood, Matthew AU - Greenwood M AD - Royal North Shore Hospital, St Leonards, Australia. FAU - Curtis, David J AU - Curtis DJ AD - The Alfred Hospital, Melbourne, Australia. FAU - Tran, Steven AU - Tran S AD - The Australasian Bone Marrow Transplant Recipient Registry, Darlinghurst, Australia. FAU - Moore, John AU - Moore J AD - St Vincent's Hospital, Darlinghurst, Australia. FAU - Hamad, Nada AU - Hamad N AD - St Vincent's Hospital, Darlinghurst, Australia. LA - eng PT - Journal Article DEP - 20231127 PL - United States TA - Transplant Cell Ther JT - Transplantation and cellular therapy JID - 101774629 RN - 8N3DW7272P (Cyclophosphamide) SB - IM MH - Humans MH - Aged MH - New Zealand/epidemiology MH - *Peripheral Blood Stem Cell Transplantation/adverse effects MH - *Leukemia, Myeloid, Acute/drug therapy MH - Cyclophosphamide/therapeutic use MH - *Hematopoietic Stem Cell Transplantation/adverse effects MH - *Graft vs Host Disease/epidemiology/prevention & control MH - *Myelodysplastic Syndromes/therapy MH - Recurrence MH - *Cytomegalovirus Infections OTO - NOTNLM OT - Elderly OT - GVHD OT - Haploidentical OT - NRM OT - Older EDAT- 2023/11/30 00:42 MHDA- 2024/03/18 06:42 CRDT- 2023/11/29 19:27 PHST- 2023/08/04 00:00 [received] PHST- 2023/11/21 00:00 [revised] PHST- 2023/11/22 00:00 [accepted] PHST- 2024/03/18 06:42 [medline] PHST- 2023/11/30 00:42 [pubmed] PHST- 2023/11/29 19:27 [entrez] AID - S2666-6367(23)01707-4 [pii] AID - 10.1016/j.jtct.2023.11.018 [doi] PST - ppublish SO - Transplant Cell Ther. 2024 Mar;30(3):334.e1-334.e7. doi: 10.1016/j.jtct.2023.11.018. Epub 2023 Nov 27.