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Outcomes of allogeneic hematopoietic stem cell transplantation from different donor types in primary refractory acute myeloid leukemia: a report from the ALWP of the EBMT

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Abstract

Primary refractory acute myeloid leukemia (prAML) is a poor prognosis disease, with allogeneic hematopoietic stem cell transplantation (allo-HSCT) being the only potentially curative option. We retrospectively evaluated outcomes in 1574 adult prAML patients who underwent allo-HSCT from matched sibling donors (MSD), 10/10 or 9/10 unrelated donors (UD), or haploidentical donors between 2015 and 2020. Median follow-up was 24, 30, 38, and 24 months for MSD, UD 10/10, UD 9/10, and haploidentical transplants, respectively. MSD recipients were younger (median age 53 vs. 58–59 years in other groups, p < 0.001), had better performance status, and proceeded to transplant more quickly (3.8 months vs. >4 months in other groups, p = 0.004). In multivariate analysis, haploidentical HSCT was associated with inferior leukemia-free survival (LFS) and overall survival (OS) compared to other donor types. Additional negative predictors included adverse cytogenetics and longer time from diagnosis to transplant. Conversely, reduced-intensity conditioning and good performance status of the patient were associated with improved LFS. Disease progression remained the leading cause of transplant failure, underscoring the urgent need for more effective early post-transplant strategies.

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The final analysis dataset will be available upon specific request to the Working Party chair.

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Acknowledgements

We thank all the EBMT participating centers for providing patients to the study.

Author information

Authors and Affiliations

  1. Hematology Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

    Kordelia Barbullushi

  2. Hematology Department, Hôpital Saint Antoine, Service d’Hématologie et Thérapie Cellulaire, Paris, France

    Myriam Labopin & Mohamad Mohty

  3. Acute Leukemia Working Party, Paris Study Office, European Society for Blood and Marrow Transplantation, Paris, France

    Myriam Labopin & Mohamad Mohty

  4. Sorbonne Université, UPMC Univ Paris 06, INSERM, Centre de Recherche Saint-Antoine (CRSA), Paris, France

    Myriam Labopin & Mohamad Mohty

  5. University Hospital Eppendorf, Bone Marrow Transplantation Centre, Hamburg, Germany

    Nicolaus Kröger

  6. University of Freiburg, Dept. of Medicine-Hematology, Oncology, Freiburg, Germany

    Jürgen Finke

  7. University of Muenster, Dept. of Hematology/Oncology, Muenster, Germany

    Matthias Stelljes

  8. Hannover Medical School, Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover, Germany

    Arnold Ganser

  9. Universitaet Tuebingen, Medizinische Klinik, Abteilung II, Tuebingen, Germany

    Wolfgang Bethge

  10. Universitaetsklinikum Wuerzburg, Med. Klinik und Poliklinik II, Wuerzburg, Germany

    Hermann Einsele

  11. University Hospital, TU Dresden, Medizinische Klinik und Poliklinik I, Dresden, Germany

    Johannes Schetelig

  12. Division of Hematology and Stem Cell Transplantation, University Hospital and DAME, Udine, Italy

    Renato Fanin

  13. Charles University Hospital, Dept. of Hematology/Oncology, Pilsen, Czech Republic

    Pavel Jindra

  14. University Hospital, Dept. of Hematology and Stem Cell Transplantation, Essen, Germany

    Thomas Schroeder

  15. Klinikum Oldenburg, Abt. Onkologie/Hämatologie, Oldenburg, Germany

    Jochen Casper

  16. University Regensburg, Dept. of Hematology and Oncology, Regensburg, Germany

    Matthias Edinger

  17. University Hospital, Hematology, Basel, Switzerland

    Jakob Passweg

  18. CHU Bordeaux, Hôpital Haut-Leveque, Pessac, France

    Edouard Forcade

  19. Klinikum Grosshadern, Med. Klinik III, Munich, Germany

    Johanna Tischer

  20. Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel

    Arnon Nagler

  21. Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Fabio Ciceri

Authors
  1. Kordelia Barbullushi
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  2. Myriam Labopin
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  3. Nicolaus Kröger
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  20. Mohamad Mohty
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Contributions

KB, ML, and MM designed the study and/or analyzed the data. KB wrote the manuscript. NK, JF, MS, AG, WB, HE, JS, RF, PJ, TS, JC, ME, JP, EF, JT were the principal investigators at the centers recruiting the highest number of patients for the study, provided important clinical data and critically revised the manuscript. MM, FC and AN approved the final version of the article.

Corresponding author

Correspondence to Kordelia Barbullushi.

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The authors declare no competing interests.

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All methods were performed in accordance with the relevant guidelines and regulations. The scientific board of the ALWP of the EBMT approved this study.

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Barbullushi, K., Labopin, M., Kröger, N. et al. Outcomes of allogeneic hematopoietic stem cell transplantation from different donor types in primary refractory acute myeloid leukemia: a report from the ALWP of the EBMT. Bone Marrow Transplant (2025). https://doi.org/10.1038/s41409-025-02740-w

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