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Comparative Study
. 2009 Mar 26;113(13):3110-8.
doi: 10.1182/blood-2008-07-163212. Epub 2008 Dec 4.

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

Olle Ringdén  1 , Steven Z Pavletic, Claudio Anasetti, A John Barrett, Tao Wang, Dan Wang, Joseph H Antin, Paolo Di Bartolomeo, Brian J Bolwell, Christopher Bredeson, Mitchell S Cairo, Robert P Gale, Vikas Gupta, Theresa Hahn, Gregory A Hale, Jorg Halter, Madan Jagasia, Mark R Litzow, Franco Locatelli, David I Marks, Philip L McCarthy, Morton J Cowan, Effie W Petersdorf, James A Russell, Gary J Schiller, Harry Schouten, Stephen Spellman, Leo F Verdonck, John R Wingard, Mary M Horowitz, Mukta Arora
Affiliations
Comparative Study

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

Olle Ringdén et al. Blood. .

Abstract

Do 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.

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Figures

Figure 1
Figure 1
(A) Adjusted probability of relapse in patients with AML receiving grafts from an unrelated donor or an HLA-identical sibling (P = .005). (B) Adjusted probability of relapse in patients with ALL receiving grafts from an unrelated donor or an HLA-identical sibling (P = .23). (C) Adjusted probability of relapse in patients with CML receiving grafts from an unrelated donor or an HLA-identical sibling (P = .25).
Figure 2
Figure 2
(A) Adjusted probability of leukemia-free survival in patients with AML receiving grafts from HLA-identical siblings or an unrelated donor (P < .001). (B) Adjusted probability of leukemia-free survival in patients with ALL receiving grafts from HLA-identical siblings or an unrelated donor (P = .67). (C) Adjusted probability of leukemia-free survival in patients with CML receiving grafts from HLA-identical siblings or an unrelated donor (P = .17).
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