Haploidentical Transplantation for Older Patients with Acute Myeloid Leukemia and Myelodysplastic Syndrome

Abstract

Allogeneic stem cell transplant (ASCT) with HLA matched donors is increasingly used for older patients with AML/MDS. It remains unclear if haploidentical transplantation (haploSCT) is a suitable option for older patients with this disease. We analyzed 43 patients with AML/MDS (median age 61 years) who underwent a haploSCT at our institution. All the patients received a fludarabine-melphalan-based reduced-intensity conditioning regimen and post-transplant cyclophosphamide-based GVHD prophylaxis. Except one patient who had early death, the remaining 42 patients (98%) engrafted donor cells. The cumulative incidence (CI) of grade 2–4 and 3–4 acute GVHD (aGVHD) at 6 months was 35% and 5% respectively and chronic GVHD (cGVHD) at 2-years was 9%. After a median follow-up of 19 months, 2-year overall (OS), progression-free survival (PFS), relapse-incidence were 42%, 42%, and 24% respectively. Best PFS (74% at 2 years) was seen in patients with intermediate/good-risk cytogenetics, in first or second remission (HR:0.4, P =0.05) and with a younger donor (≤40 years) (HR=0.2, P =0.01). In conclusion, these data suggest that haploidentical transplantation is safe and effective for older AML/MDS patients. Disease status, cytogenetics, and younger donor age are predictors for improved survival in older patients receiving a haploidentical transplant.