In the context of T-cell replete haploidentical stem cell transplantation (Haplo-SCT) using post-transplantation cyclophosphamide (PT-Cy), it is still unknown whether peripheral blood (PB) or bone marrow (BM) is the best graft source. While PB is associated with a higher incidence of graft-versus-host disease (GVHD), it may induce a stronger graft-versus-leukemia effect compared to BM, notably in acute myeloid leukemia (AML). From the EBMT registry database, we compared T-cell replete PB (n = 595) versus BM (n = 209) grafts in a large cohort of 804 patients over the age of 60 years who underwent Haplo-SCT with PT-Cy for an AML in first or second complete remission. The risk of acute GVHD was significantly higher in the PB group (Grade II-IV: HR = 1.67, 95% CI [1.10–2.54], p = 0.01; Grade III-IV: HR = 2.29, 95% CI [1.16–4.54], p = 0.02). No significant difference was observed in chronic GVHD or non-relapse mortality. In the PB group, the risk of relapse was significantly lower in the PB group (HR = 0.65, 95% CI [0.45–0.94], p = 0.02) and leukemia-free survival was significantly better (HR = 0.76, 95% CI [0.59–0.99], p = 0.04), with a trend toward better overall survival (HR = 0.78, 95% CI [0.60–1.01], p = 0.06). We conclude that in the specific context of Haplo-SCT with PT-Cy, PB grafts represent a valid option to decrease the risk of relapse and improve outcome of older AML patients who usually do not benefit from conditioning intensification.

中文翻译：

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外周血干细胞与骨髓移植治疗≥60岁的患者接受降低强度调理半相合移植治疗完全缓解的急性髓系白血病：欧洲血液和骨髓移植学会急性白血病工作组的分析


在使用移植后环磷酰胺 (PT-Cy) 进行 T 细胞填充单倍体干细胞移植 (Haplo-SCT) 的背景下，尚不清楚外周血 (PB) 还是骨髓 (BM) 是最佳移植来源。虽然 PB 与移植物抗宿主病 (GVHD) 的发生率较高有关，但与 BM 相比，它可能会诱发更强的移植物抗白血病效应，尤其是在急性髓系白血病 (AML) 中。根据 EBMT 注册数据库，我们在一个由 804 名 60 岁以上患者组成的大型队列中比较了充满 T 细胞的 PB ( n = 595) 与 BM ( n = 209) 移植物，这些患者接受了 Haplo-SCT 和 PT-Cy 治疗第一次或第二次完全缓解的 AML。 PB 组发生急性 GVHD 的风险显着较高（II-IV 级：HR = 1.67，95% CI [1.10–2.54]， p = 0.01；III-IV 级：HR = 2.29，95% CI [1.16– 4.54]， p = 0.02）。慢性 GVHD 或非复发死亡率没有观察到显着差异。在 PB 组中，PB 组的复发风险显着较低（HR = 0.65，95% CI [0.45–0.94]， p = 0.02），且无白血病生存率显着更好（HR = 0.76，95% CI） [0.59–0.99]， p = 0.04），总体生存率有改善的趋势（HR = 0.78，95% CI [0.60–1.01]， p = 0.06）。我们的结论是，在 Haplo-SCT 联合 PT-Cy 的特定背景下，PB 移植物是降低复发风险并改善通常无法从调理强化中获益的老年 AML 患者预后的有效选择。