Prospective analysis to determine barriers to allogeneic hematopoietic cell transplantation in patients with acute leukemia Journal Article
| Authors: | Nath, K.; Lee, J.; Elko, T. A.; Levy, L.; Preston, E.; Devlin, S. M.; Ponce, D. M.; Lin, R. J.; Shaffer, B. C.; Cho, C.; Politikos, I.; Jakubowski, A. A.; Park, J. H.; Rampal, R.; Perales, M. A.; Tallman, M. S.; Barker, J. N.; Berman, E.; Tamari, R.; Stein, E.; Giralt, S. A.; Gyurkocza, B. |
| Article Title: | Prospective analysis to determine barriers to allogeneic hematopoietic cell transplantation in patients with acute leukemia |
| Abstract: | Allogeneic hematopoietic cell transplantation (allo-HCT) is a potentially curative treatment for patients with acute leukemia. Despite this, studies have shown that only a minority of patients ultimately proceed to allo-HCT. The primary objective of this prospective, observational study was to identify the rate of allo-HCT in patients for whom it was recommended, and reasons why patients deemed appropriate and eligible for HCT did not subsequently undergo transplant. Between April 2016 and April 2021, adult patients with newly diagnosed or relapsed/refractory acute leukemia were enrolled at the time of induction/reinduction therapy. Initial transplantation workup and allo-HCT recommendations were made during the early phase of induction/reinduction. Of the 307 enrolled patients, allo-HCT was recommended to 85% (n = 259), of whom 66% (n = 170) underwent transplant. Donor sources comprised 54% human leukocyte antigen (HLA)-matched unrelated donors, 20% HLA-matched sibling donors and HLA-mismatched graft sources with 15% umbilical cord blood units, 8% HLA-mismatched unrelated donors, and 4% HLA-haploidentical donors. The most common reason for transplant disqualification in the 89 patients in whom it was initially recommended was persistent/relapsed disease (70%), followed by early patient death (10%). In this prospective study, we report a high allo-HCT rate, which may be due to early transplant referral and workup. The main allo-HCT barrier was disease control, followed by early patient death. With the increasing availability of HLA-mismatched graft sources, the lack of donor availability was not a transplant barrier. Further development of novel transplant strategies for patients not achieving remission and improvements in induction regimens could result in increased allo-HCT utilization. © 2023 Wiley Periodicals LLC. |
| Keywords: | adult; aged; retrospective studies; transplantation, homologous; major clinical study; leukemia, myeloid, acute; cancer recurrence; prospective study; prospective studies; hematopoietic stem cell transplantation; retrospective study; acute leukemia; death; graft versus host reaction; allogeneic hematopoietic stem cell transplantation; umbilical cord blood; cancer control; observational study; graft vs host disease; leukocyte antigen; hla antigen; hla antigens; patient referral; allotransplantation; acute disease; unrelated donor; acute myeloid leukemia; unrelated donors; humans; human; male; female; article; haploidentical donor; matched unrelated donor; matched sibling donor |
| Journal Title: | American Journal of Hematology |
| Volume: | 98 |
| Issue: | 12 |
| ISSN: | 0361-8609 |
| Publisher: | John Wiley & Sons, Inc. |
| Date Published: | 2023-12-01 |
| Start Page: | 1869 |
| End Page: | 1876 |
| Language: | English |
| DOI: | 10.1002/ajh.27084 |
| PUBMED: | 37688521 |
| PROVIDER: | scopus |
| PMCID: | PMC10697699 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF -- Corresponding author is MSK author: Boglarka Gyurkocza -- Source: Scopus |
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