Use of PTCy in 1Ag-MMUD-HCT as a Valid Alternative to Haploidentical-HCT: A Study From the Acute Leukemia Working Party of the EBMT

In a retrospective study, published in the Bone Marrow Transplantation journal, researchers explored differences in outcomes when using one-antigen mismatched unrelated donor (1Ag-MMUD) hematopoietic cell transplantation (HCT) compared to haploidentical-HCT, with post-transplant cyclophosphamide (PTCy) treatment. The authors demonstrated an advantage in leukemia-free survival (LFS) and overall survival (OS) when using 1Ag-MMUD-HCT over haplo-HCT, in the context of PTCy treatment.

HCT serves as a curative therapy for hematologic malignancies but, this treatment can lead to graft-versus-host disease (GVHD). Patients which do not have an HLA-identical sibling or matched unrelated donor (MUD) may use a haploidentical donor or MMUD. In these cases, treatment with PTCy greatly reduces the level of GVHD. In this study, the authors sought to determine differences in outcomes by using 1Ag-MMUD or haploidentical donor with PTCy treatment.

This study looked at acute myelogenous leukemia (AML) patients and included 1,751 patients (155 1Ag-MMUD-PB and 1,596 haploidentical donor receiving groups). At 2 years, the 1Ag-MMUD-PB group had a higher chance of OS (72%) compared to the haploidentical group (60%), p=0.03. Similarly, the LFS was 67% vs 55% (p=0.03) in the 1Ag-MMUS-PB group compared to the haploidentical group. Although additional studies are required, these results suggest an advantage when using 1Ag-MMUD-HCT over haplo-HCT, with PTCy treatment. 


Battipaglia, G., Galimard, JE., Labopin, M. et al. Post-transplant cyclophosphamide in one-antigen mismatched unrelated donor transplantation versus haploidentical transplantation in acute myeloid leukemia: a study from the Acute Leukemia Working Party of the EBMT. Bone Marrow Transplant 57, 562–571 (2022). https://doi.org/10.1038/s41409-022-01577-x

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