HLA-allele matched unrelated donors compared to HLA-matched sibling donors: role of cell source and disease risk category.

Publication Type:

Journal Article

Source:

Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation, Volume 16, Issue 10, p.1382-7 (2010)

Keywords:

2010, Adolescent, Adult, Aged, Bone Marrow Transplantation, Center-Authored Paper, Child, Child, Preschool, Clinical Research Division, Disease-Free Survival, Female, Graft vs Host Disease, Hematologic Neoplasms, HLA Antigens, Humans, Infant, Kaplan-Meier Estimate, Living Donors, Male, Middle Aged, Myeloablative Agonists, Organ Specificity, Peripheral Blood Stem Cell Transplantation, Proportional Hazards Models, Research Trials Office Core Facility - Biostatistics Service, Retrospective Studies, RISK, Shared Resources, Siblings, Transplantation Conditioning, Treatment Outcome, Young Adult

Abstract:

To determine whether the risks of allogeneic transplantation are different when the donor is a fully matched unrelated donor (MUD; based on 10/10 HLA alleles) compared to an HLA-identical sibling, we performed a retrospective analysis of 1448 patients with high-risk or advanced hematologic malignancies given T-replete grafts after myeloablative conditioning. No statistically significant differences were found between recipients of a matched sibling donor (MSD) and 10/10 MUD in survival, disease-free survival (DFS), and nonrelapse mortality (NRM) for patients with high-risk disease or those given bone marrow as a graft source. However, for patients with intermediate-risk disease receiving peripheral blood grafts, we observed higher NRM and lower overall survival (OS) in the 10/10 MUD group compared to the MSD cohort. Graft-versus-host disease (GVHD) was higher in the MUD group compared to the MSD group. These results suggest that if a patient has high-risk disease and an MSD is not available, selection of an HLA-allele-matched MUD may provide similar OS and DFS, and therefore lack of an MSD in and of itself should not preclude such a patient from undergoing transplantation. However, for patients with intermediate-risk disease, transplantation with peripheral blood from a 10/10 MUD is associated with lower survival than an MSD.