The graft-versus-leukemia effect using matched unrelated donors is not superior to HLA-identical siblings for hematopoietic stem cell transplantation

Blood - Tập 113 - Trang 3110-3118 - 2009
Olle Ringdén1, Steven Z. Pavletic2, Claudio Anasetti3, A. John Barrett2, Tao Wang4, Dan Wang4, Joseph H. Antin5, Paolo Di Bartolomeo6, Brian J. Bolwell7, Christopher Bredeson4, Mitchell S. Cairo8, Robert P. Gale9, Vikas Gupta10, Theresa Hahn11, Gregory A. Hale12, Jorg Halter13, Madan Jagasia14, Mark R. Litzow15, Franco Locatelli16, David I. Marks17
1Center for Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Stockholm, Sweden
2Experimental Transplantation and Immunology Branch, National Institutes of Health, Bethesda, MD;
3BMT Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL;
4Center for International Blood and Marrow Transplant Research (CIBMTR), Medical College of Wisconsin, Milwaukee;
5Dana-Farber Cancer Institute/ Brigham and Women's Hospital, Boston, MA
6Department of Haematology, Ospedale Civile, Pescara, Italy;
7Cleveland Clinic Foundation, OH;
8Pediatrics, Columbia University Medical Center, New York, NY
9Center for Advanced Studies in Leukemia, Los Angeles, CA
10BMT Program, Princess Margaret Hospital, Toronto, ON;
11Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY
12St Jude Children’s Research Hospital, Memphis, TN
13University Hospital-Basel, Basel, Switzerland
14Hematology/Stem Cell Transplantation, Vanderbilt University Medical Center, Nashville, TN;
15Mayo Clinic, Rochester, MN
16Pediatric Hematology-Oncology, IRCCS Policlinico San Matteo, Pavia, Italy;
17Adult BMT Unit, United Bristol Healthcare Trust, Bristol, United Kingdom;

Tóm tắt

AbstractDo some patients benefit from an unrelated donor (URD) transplant because of a stronger graft-versus-leukemia (GVL) effect? We analyzed 4099 patients with acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), and chronic myeloid leukemia (CML) undergoing a myeloablative allogeneic hematopoietic cell transplantation (HCT) from an URD (8/8 human leukocyte antigen [HLA]–matched, n = 941) or HLA-identical sibling donor (n = 3158) between 1995 and 2004 reported to the CIBMTR. In the Cox regression model, acute and chronic GVHD were added as time-dependent variables. In multivariate analysis, URD transplant recipients had a higher risk for transplantation-related mortality (TRM; relative risk [RR], 2.76; P < .001) and relapse (RR, 1.50; P < .002) in patients with AML, but not ALL or CML. Chronic GVHD was associated with a lower relapse risk in all diagnoses. Leukemia-free survival (LFS) was decreased in patients with AML without acute GVHD receiving a URD transplant (RR, 2.02; P < .001) but was comparable to those receiving HLA-identical sibling transplants in patients with ALL and CML. In patients without GVHD, multivariate analysis showed similar risk of relapse but decreased LFS for URD transplants for all 3 diagnoses. In conclusion, risk of relapse was the same (ALL, CML) or worse (AML) in URD transplant recipients compared with HLA-identical sibling transplant recipients, suggesting a similar GVL effect.

Tài liệu tham khảo

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Blood

Tập 113

3110-3118

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