How to reduce the risk of primary engraftment failure after haploidentical hematopoietic stem cell transplantation in patients with acute myeloid leukemia?
Background. Haploidentical hematopoietic stem cell transplantation (haplo‑HSCT) represents an important alternative for patients with acute myeloid leukemia (AML) who lack an HLA‑matched donor. However, the high incidence of primary graft failure remains a significant challenge. Optimizing transplan...
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| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | Russian |
| Published: |
ABV-press
2025-03-01
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| Series: | Онкогематология |
| Subjects: | |
| Online Access: | https://oncohematology.abvpress.ru/ongm/article/view/1010 |
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| Summary: | Background. Haploidentical hematopoietic stem cell transplantation (haplo‑HSCT) represents an important alternative for patients with acute myeloid leukemia (AML) who lack an HLA‑matched donor. However, the high incidence of primary graft failure remains a significant challenge. Optimizing transplantation strategies, including the selection of the graft source and modification of conditioning regimens, may improve haplo‑HSCT outcomes. Aim. To evaluate the results of haplo‑HSCT in AML patients in first remission, focusing on engraftment rates and the factors influencing them. Materials and methods. Seventy‑three AML patients in first remission who underwent haplo‑HSCT between 2015 and 2024 were included in the study. Engraftment was defined as achieving an absolute neutrophil count of ≥ 0.5 × 109 / L and a leukocyte count of ≥ 1 × 109 / L for three consecutive days and was assessed using cumulative incidence functions with death as a competing event. Results. The engraftment rate was 80.8 % (95 % confidence interval (CI) 69.5–88.3) with a median time of 20 (15–31) days. A higher probability of engraftment was associated with the use of peripheral blood stem cells as the graft source (hazard ratio (HR) 2.62; 95 % CI 1.5–4.58; p < 0.001), myeloablative conditioning (HR 2.29; 95 % CI 1.17–4.45; p = 0.015), a higher Cd34+ cell count in the graft (HR 1.17; 95 % CI 1.05–1.31; p = 0.004), pre‑transplant biological therapy (HR 2.28; 95 % CI 1.33–3.91; p = 0.003), and the inclusion of bendamustine in the conditioning regimen (HR 2.32; 95 % CI 1.33–4.03; p = 0.003). Moreover, the use of peripheral blood stem cells, myeloablative conditioning, and bendamustine significantly reduced the time to engraftment (p = 0.016; p = 0.017; and p = 0.033, respectively). An increased level of Cd34+ cells in the graft correlated with faster engraftment (R = –0.34; p = 0.009). The engraftment rate after a second transplantation was 55.6 % (95 % CI 16.9–82.3). Conclusion. Haplo‑HSCT remains an important therapeutic option for AML patients in first remission, although its efficacy is limited by the risk of primary graft failure. The use of peripheral blood stem cells, myeloablative conditioning regimens, and modified protocols incorporating bendamustine enhances the probability of engraftment. Of additional interest is the observed positive effect of preceding venetoclax‑based biological therapy. despite the high risk of transplant‑related mortality, a second transplantation appears to be an optimal strategy in cases of primary graft failure. |
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| ISSN: | 1818-8346 2413-4023 |