ASH 2024 | A study investigating the optimal donor type for alloSCT in secondary AML

Secondary AML is a high-risk AML and we have shown that with haploidentical transplant you can overcome some of the risk in the prognosis of secondary AML because the result of haplo with PTCy in secondary AML is there in remission or in primary refractory resistant disease were similar to the de novo AML. However, there is no study that compares haploidentical transplant to sibling transplantation or unrelated transplant in secondary AML. So we performed a comparison of haplo, we have like 150 patients with haplo, 2,500 with unrelated, and under 150 with sibling transplantation. And sibling transplantation was the best type of donor. So in multivariate analysis, when you compare haplos to sibling transplantation, in haplos there is a lower relapse rate. So it’s about 20% compared to 40% with sibling transplantation. but the overall survival is lower, and there is a higher risk of acute GvHD, either total or severe acute GvHD, and also engraftment with haploid, both for ANC and platelet, is lower. When you compare haploid to unrelated transplant, there was no difference beside that in haploid, the non-relapse mortality was higher, and also engraftment was lower. So the best donor for allogeneic transplant in patients with secondary AML, according to this analysis, is sibling transplant.

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