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EBMT 2021 | Haploidentical versus unrelated transplant in ALL

Arnon Nagler, MD, MSc, Chaim Sheba Medical Center, Tel-Hashomer, Israel, gives a summary of his talk on haploidentical versus unrelated transplantation for patients with acute lymphoblastic leukemia (ALL). Prof. Nagler reports that haploidentical and unrelated transplantation achieve the same results in patients with acute myeloid leukemia. Comparison of haploidentical and unrelated transplantation in patients with ALL has found that they also report similar overall survival and leukemia-free survival results. However, a lower relapse rate and a higher rate of acute graft-versus-host disease has been observed in patients with ALL receiving haploidentical transplantation compared to those receiving sibling transplantation. This interview took place during the 47th Annual Meeting of the European Group for Blood and Marrow Transplantation (EBMT) 2021.

Transcript (edited for clarity)

Haploidentical transplant results are really improving. Therefore, we can, there are a few already for a few years, to compare haploidentical transplant to unrelated transplantation. And so, we did several works in Acute Leukemia Working Party comparing haploidentical transplant to unrelated transplantation in AML in the last few years. And we have shown that the results are exactly the same. Between haploidentical transplant and unrelated transplantation, in some of the instances, 10 out of 10 unrelated transplant is better, but haploidentical transplant in many of other studies or part of the studies are similar to unrelated, and for sure similar to nine out of 10, so one locus mismatch unrelated...

Haploidentical transplant results are really improving. Therefore, we can, there are a few already for a few years, to compare haploidentical transplant to unrelated transplantation. And so, we did several works in Acute Leukemia Working Party comparing haploidentical transplant to unrelated transplantation in AML in the last few years. And we have shown that the results are exactly the same. Between haploidentical transplant and unrelated transplantation, in some of the instances, 10 out of 10 unrelated transplant is better, but haploidentical transplant in many of other studies or part of the studies are similar to unrelated, and for sure similar to nine out of 10, so one locus mismatch unrelated.

We moved then and we compared haploidentical transplant to unrelated transplantation in ALL. So, ALL is a more difficult disease than AML. It’s harder, it used to be harder to cure. ALL and AML, now I’m not sure because there is a lot, as I say, a lot of development in ALL with BiTE, bispecific antibodies, blinatumomab, inotuzumab and CAR T-cells, but we, so we, compared the haploidentical transplant to unrelated transplantation in ALL, and showed in – one of them was together with CLMTR – that we compared haplo to eight out of eight unrelated. And then there is from the EBMT in which we compared haplo to 10 out of 10, and nine out of 10 unrelated that show exactly similar results.

So, we dared then say, you know, that the result of haplo is so improving we can dare and compare the haploidentical transplantation to sibling transplantation in ALL. And this is one of the presentations that I gave, I guess, months ago and we will discuss it in the EBMT this time.

So, the results of the haploidentical transplant as for leukemia-free survival, overall survival and the composite endpoint of GvHD relapse-free survival, was similar between haploidentical transplant and sibling transplantation, almost unbelievable in ALL. The relapse rate is lower in the haploidentical transplant compared to the sibling because, because of the broader HLA disparity that is stronger in GvL, graft-versus-leukemia, so, immunological attacks of the donor T-cells against the patient’s leukemic cells, and therefore less relapse in haplo compared to sibling. But in chronic GvHD was lower with the haploidentical transplant but acute GvHD was higher in the haploidentical transplant.

And the recent data, mainly from China, that looked at MRD in patients with ALL and compared haplo to sibling transplantation and showed that achieving MRD-negativity was better with haploidentical transplant compared to sibling transplantation, again showing the graft-versus-leukemia effect in haplo is stronger than in sibling transplantation. So, I mean, there is a lot of improvement in the result of acute lymphatic leukemia, of transplant in acute lymphatic leukemia and mainly of haploidentical transplantation.

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