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Alternative donors provide comparable results to matched unrelated donors in patients with acute lymphoblastic leukemia undergoing allogeneic stem cell transplantation in second complete remission: a report from the EBMT Acute Leukemia Working Party

Bone Marrow Transplantation volume 55, pages 1763–1772 (2020)Cite this article

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Abstract

Relapse of acute lymphoblastic leukemia (ALL) remains a major therapeutic challenge. Despite the consensus for proceeding to allogeneic stem cell transplantation (HSCT) in relapsing patients with ALL who achieve second complete remission (CR2) with salvage therapy, most patients lack a suitable matched-related histocompatible donor. The present multicenter retrospective study compared, for ALL patients in CR2, the HSCT outcome from all four possible alternative hematopoietic stem cell sources, namely matched unrelated 10/10 (n = 281), mismatched unrelated 9/10 (n = 125), haploidentical (n = 105), and cord blood (n = 104) donors. The 2-year outcomes were not statistically different between the four donor sources with respect to overall survival (38.3–47.2%), leukemia-free survival (30.5–39.6%), relapse incidence (32.6–37.6%), nonrelapse mortality (27.5–34.6%), and graft-versus-host disease-free relapse survival (21.4–33.1%). Donor choices for ALL patients achieving CR2 post first relapse are broad, ensuring that most patient in need secures a graft. Therefore, in practice, the donor choice should depend on timely availability and policy center.

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Fig. 1: Leukemia-free survival (LFS), overall survival (OS), relapse incidence (RI) and nonrelapse mortality (NRM), graft-versus-host disease-free, relapse-free survival (GRFS) in allograft patients with acute lymphoblastic leukemia in second complete remission.

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Acknowledgements

We thank all the participating centers of the EBMT and national registries for providing patients for the study, and data managers for their valuable contribution (Additional file 1).

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Author notes

  1. These authors contributed equally: Mohamad Mohty, Arnon Nagler

Authors and Affiliations

  1. Sorbonne University, service d’Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, APHP, INSERM U938 centre de Recherche Saint-Antoine, Paris, France

    Eolia Brissot, Myriam Labopin & Mohamad Mohty

  2. Acute Leukemia Working Party office, Hôpital Saint Antoine, APHP, Paris, France

    Eolia Brissot, Myriam Labopin, Mohamad Mohty & Arnon Nagler

  3. Unit of Blood Disease and Stem Cell Transplantation, DPT of Medical and Experimental Sciences, Brescia University, ASST Spedali Civili di Brescia, Brescia, Italy

    Domenico Russo

  4. Robert-Bosch-Krankenhaus, Abt. Hämatologie/Onkologie, Stuttgart, Germany

    Sonja Martin

  5. Universitaets-Klinikum Augsburg, II Medizinische Klinik, Augsburg, Germany

    Christoph Schmid

  6. Department of Haematology, Asklepios Klinik St. Georg, Hamburg, Germany

    Bertram Glass

  7. Tel Aviv Sourasky Medical Center, Blood and Bone Marrow Transplantation, Tel Aviv, Israel

    Ron Ram

  8. Gazi University Faculty of Medicine, Hematology, Ankara, Turkey

    Zubeyde Nur Ozkurt

  9. University Hospital, Hematology, Basel, Switzerland

    Jakob Passweg

  10. Leiden University Hospital, BMT Centre Leiden, Leiden, The Netherlands

    Joan Hendrik Veelken

  11. Klinik fuer Innere Medizin III, Universtätklinikum, Ulm, Germany

    Donald Bunjes

  12. Department of Haematology, Imperial College, Hammersmith Hospital, London, UK

    Jane Apperley

  13. Department of Bone Marrow Transplantation, Branch Gliwice, Comprehensive Cancer Center M. Sklodowska-Curie Memorial Institute, Gliwice, Poland

    Sebastian Giebel

  14. Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel

    Arnon Nagler

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Contributions

EB, ML, SG, MM, and AN designed the study and/or analyzed the data. DR, SM, CS, BG, RR, ZNO, JP, JH, DB, JA provided important clinical data. All authors contributed to the writing of the report and approved the final version of the article.

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Correspondence to Eolia Brissot.

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Brissot, E., Labopin, M., Russo, D. et al. Alternative donors provide comparable results to matched unrelated donors in patients with acute lymphoblastic leukemia undergoing allogeneic stem cell transplantation in second complete remission: a report from the EBMT Acute Leukemia Working Party. Bone Marrow Transplant 55, 1763–1772 (2020). https://doi.org/10.1038/s41409-020-0849-x

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