{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,21]],"date-time":"2026-06-21T11:13:44Z","timestamp":1782040424494,"version":"3.54.5"},"reference-count":16,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T00:00:00Z","timestamp":1744675200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Over the last decades, the donor network for hematopoietic cell transplantation (HCT) has grown exponentially, including unrelated and haploidentical (Haplo) donors. This study aimed to describe HCT outcomes with MSD, Haplo, and matched unrelated donors (MUD) in an early period of Haplo with posttransplant cyclophosphamide in a developing country with a large unrelated donor registry.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study was conducted in collaboration with the CIBMTR. We included patients with acute leukemias undergoing HCT between 2014-2018.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>With 595 patients, 2-year overall survival (OS) was 69% for the MSD, 65% for the Haplo, and 71% for MUD (p=0.24) in CR1, confirmed in multivariable analysis. Relapse rate was lower for MUD (HR=0.35, p=0.0005) than MSD in patients with CR2+, leading to higher OS. Relapse was also higher with Haplo compared with MUD (HR=2.06, p=0.03).<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Only survival bias can explain these findings in CR2+, suggesting some high-risk MUD patients, in which HCT timing is crucial, may not achieve HCT. Alternative donors were associated with higher non-relapse mortality, while PTCy-based Haplo offered the best protection against chronic graft-versus-host disease. Our study suggests Haplo and MUD are acceptable options for patients lacking MSD in developing countries like ours.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2025.1584631","type":"journal-article","created":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T06:02:06Z","timestamp":1744696926000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Haploidentical, matched-related, and matched-unrelated hematopoietic cell transplant for acute leukemias in the early years of haploidentical transplant implementation in a developing country with a large unrelated donor registry"],"prefix":"10.3389","volume":"15","author":[{"given":"Adriana","family":"Seber","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo Javier","family":"Arcuri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vergilio Rensi","family":"Colturato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mair Pedro","family":"Souza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yana Augusta Novis","family":"Zogbi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vaneuza","family":"Funke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Decio","family":"Lerner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Cristina","family":"Macedo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liane","family":"Daudt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariana Nassif","family":"Kerbauy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor Gottardello","family":"Zecchin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando Barroso","family":"Duarte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo","family":"Rabello Chiattone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodolfo Daniel de Almeida","family":"Soares","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gustavo","family":"Bettarello","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Vaz de Macedo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo","family":"Paton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatiana Dias Marconi","family":"Monteiro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayr","family":"Schmidt Filho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia Caceres","family":"Astigarraga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phillip","family":"Scheinberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afonso Celso","family":"Vigorito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen Silvia Vieitas","family":"Vergueiro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anderson","family":"Simione","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahrukh","family":"Hashmi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wael","family":"Saber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinalben","family":"Patel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmem Maria Sales","family":"Bonfim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcelo","family":"Pasquini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary Evelyn","family":"Flowers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nelson","family":"Hamerschlak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,4,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1007\/s00251-018-1059-1","article-title":"The distribution of HLA haplotypes in the ethnic groups that make up the Brazilian bone marrow volunteer donor registry (REDOME)","volume":"70","author":"Halagan","year":"2018","journal-title":"Immunogenetics"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2008.03.005","article-title":"HLA-haploidentical bone marrow transplantation for hematologic Malignancies using nonmyeloablative conditioning and high-dose, posttransplantation cyclophosphamide","volume":"14","author":"Luznik","year":"2008","journal-title":"Biol Blood Marrow Transplant"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2011.10.008","article-title":"Comparison of unrelated cord blood transplantation and HLA-mismatched unrelated bone marrow transplantation for adults with leukemia","volume":"18","author":"Atsuta","year":"2012","journal-title":"Biol Blood Marrow Transplant"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.12291","article-title":"Eligibility for allogeneic transplantation in very high risk childhood acute lymphoblastic leukemia: the impact of the waiting time","volume":"93","author":"Balduzzi","year":"2008","journal-title":"Haematologica"},{"key":"B5","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1186\/s13045-016-0248-3","article-title":"Impact of conditioning intensity in T-replete haplo-identical stem cell transplantation for acute leukemia: A report from the acute leukemia working party of the EBMT","volume":"9","author":"Rubio","year":"2016","journal-title":"J Hematol Oncol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1038\/s41409-022-01674-x","article-title":"Reduced intensity versus non-myeloablative conditioning regimen for haploidentical transplantation and post-transplantation cyclophosphamide in complete remission acute myeloid leukemia: A study from the ALWP of the EBMT","volume":"57","author":"Devillier","year":"2022","journal-title":"Bone Marrow Transplant"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtct.2021.06.011","article-title":"Outcomes after haploidentical hematopoietic cell transplantation with post-transplantation cyclophosphamide: A systematic review and meta-analysis comparing myeloablative with reduced-intensity conditioning regimens and bone marrow with peripheral blood stem cell grafts","volume":"27","author":"Arcuri","year":"2021","journal-title":"Transplant Cell Ther"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2023.284445","article-title":"Matched unrelated donor transplantation versus haploidentical transplantation with post-transplant cyclophosphamide in children with acute myeloid leukemia: a PDWP-EBMT study","volume":"109","author":"Ruggeri","year":"2024","journal-title":"Haematologica"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1111\/tid.13626","article-title":"Clinical impact of multiple DNA virus infections in nondepleted haploidentical and unrelated allogeneic hematopoietic stem cell transplantation","volume":"23","author":"Kerbauy","year":"2021","journal-title":"Transplant Infect Dis"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1038\/s41409-021-01328-4","article-title":"Severe infections and infection-related mortality in a large series of haploidentical hematopoietic stem cell transplantation with post-transplant cyclophosphamide","volume":"56","author":"Esquirol","year":"2021","journal-title":"Bone Marrow Transplant"},{"key":"B11","doi-asserted-by":"publisher","first-page":"395.e1","DOI":"10.1016\/j.jtct.2022.04.020","article-title":"Haploidentical versus Matched Unrelated versus Matched Sibling Donor Hematopoietic Cell Transplantation with Post-Transplantation Cyclophosphamide","volume":"28","author":"Mehta","year":"2022","journal-title":"Transplant Cell Ther"},{"key":"B12","doi-asserted-by":"publisher","first-page":"233.e1","DOI":"10.1016\/j.jtct.2023.11.015","article-title":"Opportunistic infections in patients receiving post-transplantation cyclophosphamide: impact of haploidentical versus unrelated donor allograft","volume":"30","author":"Little","year":"2024","journal-title":"Transplant Cell Ther"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD009159.pub3","article-title":"Polyclonal anti-thymocyte globulins for the prophylaxis of graft-versus-host disease after allogeneic stem cell or bone marrow transplantation in adults","volume":"6","author":"Chakupurakal","year":"2023","journal-title":"Cochrane Database Syst Rev"},{"key":"B14","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1056\/NEJMoa1506002","article-title":"Antilymphocyte globulin for prevention of chronic graft-versus-host disease","volume":"374","author":"Kr\u00f6ger","year":"2016","journal-title":"New Engl J Med"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.46765\/2675-374X.2023v4n2p200","article-title":"Current use and outcomes of hematopoietic stem cell transplantation: Brazilian summary slides - 2023","volume":"4","author":"Simione","year":"2023","journal-title":"J Bone Marrow Transplant And Cell Ther"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2215943","article-title":"Post-transplantation cyclophosphamide-based graft-versus-host disease prophylaxis","volume":"388","author":"Bola\u00f1os-Meade","year":"2023","journal-title":"New Engl J Med"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2025.1584631\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T06:02:08Z","timestamp":1744696928000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2025.1584631\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,15]]},"references-count":16,"alternative-id":["10.3389\/fonc.2025.1584631"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2025.1584631","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,15]]},"article-number":"1584631"}}