Abstract

Haplo-cord Transplantation Vs Unrelated Donor Stem Cell Transplantation In Patients with AML/MDS older than 50

Between 2007 and 2013, 109 patients with AML/MDS who were 50 years and older and had no HLA- matched related donor underwent allogeneic hematopoietic stem cell transplant. 64 had an HLA identical unrelated donor and received fludarabine/melphalan/alemtuzumab conditioning and post transplant tacrolimus for graft vs host disease (GVHD) prophylaxis. 45 underwent haplo-cord (HC) SCT with fludarabine/melphalan/ thymoglobulin; post-transplant tacrolimus and MMF. We compared patient characteristics and transplant outcomes between both groups. (Table 1) Age distribution and ASBMT risk category were similar. There were more patient's with AML in the HC group. (P=0.01) Time to neutrophil recovery, treatment related mortality (TRM), relapse rate, progression free survival (PFS) and overall survival (OS) were nearly identical between the two groups. Time to platelet recovery was on average 5 days longer after HC (p=0.05) The incidences of acute and chronic GVHD were very low in both groups, in part due to the use of in-vivo T cell depletion.

HC transplant with reduced intensity conditioning is a curative treatment for older patients with AML/MDS who lack HLA identical unrelated donors. Despite inclusion of many patients with high risk features, nearly two thirds were estimated to be alive one year after transplant and very few had chronic GVHD. Haplo-cord grafts are more readily available, a potential advantage over MUD grafts in situations where transplant is needed urgently.

Table
 Matched Unrelated Donor Haplo Cord  
N 64 45  
Age (range) 62 (50-73) 62 (50-74)  
AML/MDS 45/20 41/5
 
0.01 
ASBMT
Low/Int /High 
21/6/30 15/10/20 0.7 
KPS  90 90  
Time to ANC >500 10 11 0.1 
Time to Plt >20 18 23 0.05 
PFS@ 1 Y (95% CI) 46 (34-58) 41 (26-56) 0.6 
OS@ 1 Y (95% CI) 57 (44-70) 64 (49-79) 0.8 
Cum Inc TRM @100 d (95% CI) 9 (2-16) 9 (0-18) 0.2 
Cum Inc TRM @ 1 Y
(95% CI) 
25 (14-36) 29 (15-44) 0.2 
Cum Inc Relapse @ 1Y (95% CI) 30 (18-42) 26 (12-40) 0.5 
Cum Inc AGVHD @ 100 D (95% CI) 25 (14-36) 29 (13-43) 0.7 
Cum Inc CGVHD @ 1 Y (95% CI) 6 (0-12) 7 (0-15) 0.9 
 Matched Unrelated Donor Haplo Cord  
N 64 45  
Age (range) 62 (50-73) 62 (50-74)  
AML/MDS 45/20 41/5
 
0.01 
ASBMT
Low/Int /High 
21/6/30 15/10/20 0.7 
KPS  90 90  
Time to ANC >500 10 11 0.1 
Time to Plt >20 18 23 0.05 
PFS@ 1 Y (95% CI) 46 (34-58) 41 (26-56) 0.6 
OS@ 1 Y (95% CI) 57 (44-70) 64 (49-79) 0.8 
Cum Inc TRM @100 d (95% CI) 9 (2-16) 9 (0-18) 0.2 
Cum Inc TRM @ 1 Y
(95% CI) 
25 (14-36) 29 (15-44) 0.2 
Cum Inc Relapse @ 1Y (95% CI) 30 (18-42) 26 (12-40) 0.5 
Cum Inc AGVHD @ 100 D (95% CI) 25 (14-36) 29 (13-43) 0.7 
Cum Inc CGVHD @ 1 Y (95% CI) 6 (0-12) 7 (0-15) 0.9 

Disclosures

van Besien:Miltenyi: Research Funding. Mark:Millennium: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Onyx: Research Funding, Speakers Bureau; Celgene: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau. Artz:Miltenyi: Research Funding.

Author notes

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