Abstract
An increasing number of older patients with acute myeloid leukemia (AML) are offered an allogeneic hematopoietic stem cell transplantation (allo-HSCT). Normally, older patients have older matched related donors (MRD). Matched unrelated donors (MUD) are an important alternative, but it remains unclear whether a younger MUD is associated with better outcomes, especially in the context of post-transplant cyclophosphamide (PTCy). We compared outcomes of patients older than 50 years with AML in first complete remission (CR1) and receiving a first HSCT from a 10/10 MUD aged younger than 40 years to those receiving a graft from a MRD aged older than 50 years, using PTCy and with well-known transplant conditioning intensity (TCI) score. A total of 345 consecutive patients were included and classified according to TCI score as low, intermediate, or high. On multivariable analysis in the TCI-intermediate/high group, MUD was associated with better graft-versus-host disease-free, relapse-free survival, lower non-relapse mortality and lower relapse incidence. For patients receiving a TCI-low regimen, outcomes are independent on the type of donor. In patients with AML in CR1, older than 50 years and receiving a TCI-intermediate/high conditioning regimen using PTCy, a MUD younger than 40 years is preferable over a MRD older than 50 years.
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Data availability
The dataset supporting the conclusions of this article is available from the ALWP of the EBMT at the Saint Antoine Hospital, Paris.
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Acknowledgements
This study was conducted on behalf of the Acute Leukemia Working Party (ALWP) of the European Society for Blood and Marrow Transplantation (EBMT). We thank all data managers from the ALWP who collected and checked data. We thank all EBMT centers for contributing patients to the study. This study was supported by the EBMT funded by annual subscription from the constituent transplant centers.
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SP, ML, MM, JS and FC: designed the study. ML: performed statistical analysis and helped with the interpretation of the results. SP: wrote the manuscript. GC, AECB, JP, EM, GVG, MR, MJPC, SS, JV, AK, AB, JS, FC: provided patients for the study. All authors reviewed and approved the manuscript.
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The scientific board of the ALWP of the EBMT approved this study. All patients gave written informed consent for the use of their data.
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Piemontese, S., Labopin, M., Choi, G. et al. Older MRD vs. younger MUD in patients older than 50 years with AML in remission using post-transplant cyclophosphamide. Leukemia 38, 2016–2022 (2024). https://doi.org/10.1038/s41375-024-02359-8
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DOI: https://doi.org/10.1038/s41375-024-02359-8
