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EBMT 2026 | Older matched sibling donor vs young haploidentical donor for alloSCT in secondary AML in CR1
Arnon Nagler, MD, Chaim Sheba Medical Center, Tel-Aviv, Israel, shares insights from a study comparing outcomes of allogeneic stem cell transplantation (alloSCT) using older matched sibling donors versus young haploidentical donors in patients with secondary acute myeloid leukemia (AML) in first complete remission (CR1). Prof. Nagler highlights comparable outcomes between these donor types, expanding the pool of donor options for patients with secondary AML. This interview took place at the 52nd Annual Meeting of the EBMT in Madrid, Spain.
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Transcript
So we did several studies in secondary AML, which is a unique type of high-risk AML that is based today on a unique profile of mutations. And we have shown in the past that the result, or we and others, of haploidentical transplantation in secondary leukemia is worse than in de novo AML. However, with the introduction of PTCy, post-transplant cyclophosphamide, that reduces chronic GVHD and transplant mortality, the result of haploidentical transplant, but also unrelated, all the biology of transplantation is changing...
So we did several studies in secondary AML, which is a unique type of high-risk AML that is based today on a unique profile of mutations. And we have shown in the past that the result, or we and others, of haploidentical transplantation in secondary leukemia is worse than in de novo AML. However, with the introduction of PTCy, post-transplant cyclophosphamide, that reduces chronic GVHD and transplant mortality, the result of haploidentical transplant, but also unrelated, all the biology of transplantation is changing. And we have shown in several papers that haplo with PTCy is the result of the transplantation in secondary AML versus de novo AML in CR1 are the same, but also in refractory disease. And in this year, we have shown that sibling donors are better than haploidentical or matched-unrelated donors, which are the same.
So now we ask, what is the role of age? Because there is a lot of many publications recently from registry data that the younger donor is better than the older donor because the immune system has a bigger repertoire, the cells are more effective, and this is extremely important. So people are going for young unrelated or young haplo and not a matched sibling. And we ask the question if this is true also in secondary AML, which is a unique disease. And we find out that actually young haplo donors below the age of 35, the results are the same if you have a young haplo donor compared to an old sibling donor above the age of 35. Besides the fact that with young haplo donors, we have slower myeloid engraftment and less chronic GVHD. But overall, the results are the same. And this is maybe good news because you can use the young haplo donor and increase the pool of donors for this secondary AML, that until now, the only curative therapy is allogeneic transplantation.
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