Selection of Suitable Alternative Donor in the Absence of Matched Sibling Donor: A Retrospective Single-Center Study to Compare between Haploidentical, 10/10 and 9/10 Unrelated Donor Transplantation

  • Maryam Barkhordar Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
  • Amir Kasaeian Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
  • Seied Asadollah Mousavi Mail Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
  • Sahar Tavakoli Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
  • Mohammad Vaezi Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
  • Hosein Kamranzadeh Foumani Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
  • Tanaz Bahri Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
  • Davood Babakhani Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
  • Leila Mirzakhani Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
  • Ashraf Mousavi Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
  • Ardeshir Ghavamzadeh Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
Keywords:
Allogeneic stem cell transplantation; Haploidentical; Mismatched related donor; Mismatched unrelated donor; Cox modelling

Abstract

Background: Finding a suitable donor at the optimal time is one of the most challenging issues in many transplant centers. We evaluated the clinical outcomes of 248 patients with acute leukemia and without matched sibling donors (MSD) who underwent alternative transplantation, including haploidentical (n=118), 10/10 matched unrelated (MUD, n=91), 9/10 mismatched unrelated (MMUD, n=21), and 9/10 mismatched related (MMRD, n=18) between January 2010 and November 2019 in our center.

Materials and Methods: The myeloablative conditioning regimen was used in most of the patients. Both post-transplant cyclophosphamide (40mg/kg at +3, +4) and pre-transplant ATG were used in most of Haploidentical transplantations. Patients with unrelated donors received ATG as a part of the conditioning regimen.

Results: The median follow-up was 31.83 months. No significant difference in probability of 3-year leukemia- free survival (LFS) and overall survival (OS) as well as 3-year relapse incidence (RI) were noted between donor sources.

A significant difference was found in the 3-year cumulative incidence (CI) of non-relapse mortality (NRM) among the donor sources: 37.89%, 24.20%, 24.30%, and 11.48%, for Haplo, 9/10 MMUD, 10/10 MUD, and 9/10 MMRD (p=0.02). Using the multivariable Cox model, the advanced age of patients and Major-ABO mismatched, were two risk factors independently associated with lower OS and DFS as well as higher NRM, whereas male donor and AML disease compared to ALL were associated with a better OS and DFS.

Conclusion: Given that no significant differences were observed in the overall outcome of Haplo with other alternative transplantations, suggesting that Haploidentical transplantation is a suitable, accessible, and inexpensive option.

 

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Published
2021-01-13
How to Cite
1.
Barkhordar M, Kasaeian A, Mousavi SA, Tavakoli S, Vaezi M, Kamranzadeh Foumani H, Bahri T, Babakhani D, Mirzakhani L, Mousavi A, Ghavamzadeh A. Selection of Suitable Alternative Donor in the Absence of Matched Sibling Donor: A Retrospective Single-Center Study to Compare between Haploidentical, 10/10 and 9/10 Unrelated Donor Transplantation. Int J Hematol Oncol Stem Cell Res. 15(1):51-60.
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