Prognostic factors in haploidentical transplantation with post-transplant cyclophosphamide for acute myeloid leukemia

Sho Shibata; Yasuyuki Arai; Tadakazu Kondo; Shohei Mizuno; Satoshi Yamasaki; Takashi Akasaka; Noriko Doki; Shuichi Ota; Yumiko Maruyama; Ken-Ichi Matsuoka; Koji Nagafuji; Tetsuya Eto; Takashi Tanaka; Hiroyuki Ohigashi; Hirohisa Nakamae; Makoto Onizuka; Takahiro Fukuda; Yoshiko Atsuta; Masamitsu Yanada

doi:10.1016/j.jcyt.2024.02.010

Prognostic factors in haploidentical transplantation with post-transplant cyclophosphamide for acute myeloid leukemia

Cytotherapy. 2024 Feb 23:S1465-3249(24)00057-4. doi: 10.1016/j.jcyt.2024.02.010. Online ahead of print.

Authors

Sho Shibata¹, Yasuyuki Arai², Tadakazu Kondo³, Shohei Mizuno⁴, Satoshi Yamasaki⁵, Takashi Akasaka⁶, Noriko Doki⁷, Shuichi Ota⁸, Yumiko Maruyama⁹, Ken-Ichi Matsuoka¹⁰, Koji Nagafuji¹¹, Tetsuya Eto¹², Takashi Tanaka¹³, Hiroyuki Ohigashi¹⁴, Hirohisa Nakamae¹⁵, Makoto Onizuka¹⁶, Takahiro Fukuda¹³, Yoshiko Atsuta¹⁷, Masamitsu Yanada¹⁸

Affiliations

¹ Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
² Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Center for Research and Application of Cellular Therapy, Kyoto University Hospital, Kyoto, Japan. Electronic address: ysykrai@kuhp.kyoto-u.ac.jp.
³ Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan.
⁴ Division of Hematology, Department of Internal Medicine, Aichi Medical University, Nagakute, Japan.
⁵ Department of Internal Medicine, Kyushu University Beppu Hospital, Beppu, Japan.
⁶ Department of Hematology, Tenri Hospital, Tenri, Japan.
⁷ Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.
⁸ Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan.
⁹ Department of Hematology, University of Tsukuba Hospital, Tsukuba, Japan.
¹⁰ Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan.
¹¹ Division of Hematology and Oncology, Department of Medicine, Kurume University Hospital, Kurume, Japan.
¹² Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan.
¹³ Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan.
¹⁴ Department of Hematology, Hokkaido University Hospital, Sapporo, Japan.
¹⁵ Department of Hematology, Osaka Metropolitan University Hospital, Osaka, Japan.
¹⁶ Department of Hematology/Oncology, Tokai University School of Medicine, Isehara, Japan.
¹⁷ Japanese Data Center for Hematopoietic Cell Transplantation, Nagakute, Japan; Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Nagakute, Japan.
¹⁸ Department of Hematology and Oncology, Nagoya City University East Medical Center, Nagoya, Japan.

PMID: 38466265
DOI: 10.1016/j.jcyt.2024.02.010

Abstract

Background aims: Haploidentical hematopoietic stem cell transplantation (haplo-HCT) is an appropriate option when an HLA-matched related or unrelated donor is not available. Haplo-HCT using post-transplant cyclophosphamide (PTCy) is being increasingly performed worldwide due to its effective suppression of GVHD and its safety.

Methods: We conducted a large nationwide cohort study to retrospectively analyze 366 patients with acute myeloid leukemia undergoing haplo-HCT with PTCy between 2010 and 2019 and to identify prognostic factors.

Results: A multivariate Cox analysis revealed that an older recipient age (≥60 years), a male donor to a male recipient, a cytomegalovirus IgG-negative donor to a cytomegalovirus IgG-positive recipient, a poor cytogenetic risk, a noncomplete remission status at the time of transplantation, and a history of HCT were independently associated with worse overall survival (OS). Based on each hazard ratio, these factors were scored (1-2 points) and stratified by their total score into three groups: favorable (0-1 points), intermediate (2-3 points), and poor (4 points or more) groups, and 2-year OS rates were 79.9%, 49.2%, and 25.1%, respectively (P < 0.001).

Conclusions: The present study revealed significant prognostic factors in haplo-HCT with PTCy, and a scoring system based on these factors may be used to predict outcomes.

Keywords: GVHD prophylaxis; acute myeloid leukemia; haploidentical hematopoietic stem cell transplantation; post-transplant cyclophosphamide.