Blood Journal
Leading the way in experimental and clinical research in hematology

Comparable survival after HLA-well-matched unrelated or matched sibling donor transplantation for acute myeloid leukemia in first remission with unfavorable cytogenetics at diagnosis

  1. Vikas Gupta1,
  2. Martin S. Tallman2,
  3. Wensheng He3,
  4. Brent R. Logan3,
  5. Edward Copelan4,
  6. Robert Peter Gale5,
  7. Hanna J. Khoury6,
  8. Thomas Klumpp7,
  9. John Koreth8,
  10. Hillard M. Lazarus9,
  11. David I. Marks10,
  12. Rodrigo Martino11,
  13. David A. Rizzieri12,
  14. Jacob M. Rowe13,
  15. Mitchell Sabloff14,
  16. Edmund K. Waller6,
  17. John F. DiPersio15,
  18. Donald W. Bunjes16, and
  19. Daniel J. Weisdorf17
  1. 1Princess Margaret Hospital, University of Toronto, Toronto, ON;
  2. 2Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, NY;
  3. 3Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee;
  4. 4Cleveland Clinic Foundation, OH;
  5. 5Celgene Corporation, Summit, NJ;
  6. 6Emory University Hospital, Atlanta, GA;
  7. 7Fox Chase–Temple BMT Program, Philadelphia, PA;
  8. 8Dana-Farber Cancer Institute, Boston, MA;
  9. 9University Hospitals Case Medical Center, Cleveland, OH;
  10. 10Bristol Children's Hospital, Bristol, United Kingdom;
  11. 11Hospital de la Santa Creu i Sant Pau, Barcelona, Spain;
  12. 12Duke University Medical Center, Durham, NC;
  13. 13Rambam Medical Center, Haifa, Israel;
  14. 14Ottawa Hospital Blood and Marrow Transplant Program, Ottawa, ON;
  15. 15Barnes Jewish Hospital, St Louis, MO;
  16. 16Universitatsklinikum Ulm, Ulm, Germany; and
  17. 17University of Minnesota Medical Center, Minneapolis

Abstract

We compared the outcomes of unrelated donor (URD, n = 358) with human leukocyte antigen (HLA)–matched sibling donor (MSD, n = 226) transplantations in patients with acute myeloid leukemia (AML) in first complete remission (CR1) having unfavorable cytogenetics at diagnosis. Unfavorable cytogenetic abnormalities were: complex (≥ 3 abnormalities), 32%; and noncomplex involving chromosome 7, 25%; chromosome 5, 9%; 11q or MLL rearrangements, 18%; t(6;9), 5%; and other noncomplex, 10%. URDs were HLA-well-matched (n = 254; 71%) or partially-matched (n = 104; 29%). Three-year leukemia-free survival (LFS) for MSD was 42% (95% confidence interval [CI], 35%-48%) compared with 34% (95% CI, 28%-41%) for HLA-well-matched URD and 29% (95% CI, 20%-39%) for partially-matched URD (P = .08). In multivariate analysis, HLA-well-matched URD and MSD yielded similar LFS (relative risk [RR] = 1.1, 95% CI, 0.86-1.40, P = .44) and overall survival (OS; RR = 1.06, 95% CI, 0.83-1.37, P = .63). LFS and OS were significantly inferior for HLA-partially-matched URD recipients, those with prior myelodysplastic syndrome, and those older than 50 years. All cytogenetic cohorts had similar outcomes. Patients with chronic graft-versus-host disease had a significantly lower risk of relapse (RR = 0.68, 95% CI, 0.47-0.99, P = .05). Hematopoietic cell transplantation (HCT) using HLA-well-matched URD and MSD resulted in similar LFS and OS in AML patients in CR1 with unfavorable cytogenetics. Outcomes of HCT from HLA-partially- matched URD were inferior.

  • Submitted April 2, 2010.
  • Accepted May 20, 2010.
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