Comparison of matched unrelated and matched related donor myeloablative hematopoietic cell transplantation for adults with acute myeloid leukemia in first remission.

Publication Type:

Journal Article

Source:

Leukemia : official journal of the Leukemia Society of America, Leukemia Research Fund, U.K, Volume 24, Issue 7, p.1276-82 (2010)

Keywords:

2010, Adolescent, Adult, Aged, Center-Authored Paper, Child, Clinical Research Division, Female, Graft vs Host Disease, hematopoietic stem cell transplantation, Histocompatibility Testing, HLA Antigens, Humans, Leukemia, Myeloid, Acute, Living Donors, Male, Middle Aged, Neoplasm Recurrence, Local, Remission Induction, Retrospective Studies, Survival Rate, Treatment Outcome, Young Adult

Abstract:

Hematopoietic cell transplantation (HCT) from a matched related donor (MRD) benefits many adults with acute myeloid leukemia (AML) in first complete remission (CR1). The majority of patients does not have such a donor and will require an alternative donor if HCT is to be undertaken. We retrospectively analyzed 226 adult AML CR1 patients undergoing myeloablative unrelated donor (URD) (10/10 match, n=62; 9/10, n=29) or MRD (n=135) HCT from 1996 to 2007. The 5-year estimates of overall survival, relapse and nonrelapse mortality (NRM) were 57.9, 29.7 and 16.0%, respectively. Failure for each of these outcomes was slightly higher for 10/10 URD than MRD HCT, although statistical significance was not reached for any end point. The adjusted hazard ratios (HRs) were 1.43 (0.89-2.30, P=0.14) for overall mortality, 1.17 (0.66-2.08, P=0.60) for relapse and 1.79 (0.86-3.74, P=0.12) for NRM, respectively, and the adjusted odds ratio for grades 2-4 acute graft-versus-host disease was 1.50 (0.70-3.24, P=0.30). Overall mortality among 9/10 and 10/10 URD recipients was similar (adjusted HR 1.16 (0.52-2.61), P=0.71). These data indicate that URD HCT can provide long-term survival for CR1 AML; outcomes for 10/10 URD HCT, and possibly 9/10 URD HCT, suggest that this modality should be considered in the absence of a suitable MRD.