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. 2009 Apr 1;27(10):1644-52.
doi: 10.1200/JCO.2008.18.7740. Epub 2009 Feb 17.

HLA-identical sibling compared with 8/8 matched and mismatched unrelated donor bone marrow transplant for chronic phase chronic myeloid leukemia

Mukta Arora  1 , Daniel J Weisdorf, Stephen R Spellman, Michael D Haagenson, John P Klein, Carolyn K Hurley, George B Selby, Joseph H Antin, Nancy A Kernan, Craig Kollman, Auayporn Nademanee, Philip McGlave, Mary M Horowitz, Effie W Petersdorf
Affiliations

HLA-identical sibling compared with 8/8 matched and mismatched unrelated donor bone marrow transplant for chronic phase chronic myeloid leukemia

Mukta Arora et al. J Clin Oncol. .

Abstract

Purpose: Transplantation of hematopoietic stem cells from an unrelated donor (URD) is an option for many patients who do not have an HLA-identical sibling donor (MSD). Current criteria for the selection of URDs include consideration for HLA alleles determined by high resolution typing methods, with preference for allele-matched donors. However, the utility and outcome associated with transplants from URDs compared with those from MSDs remains undefined.

Patients and methods: We examined clinical outcome after patients received bone marrow transplants (BMTs) from MSDs; HLA-A, -B, -C, and DRB1 allele-matched URDs (8/8); and HLA-mismatched URDs in a homogeneous population of patients with chronic myeloid leukemia (CML) in first chronic phase (CP1) where a strong allogeneic effect and hence a lower risk of relapse is anticipated. Transplantation outcomes were compared between 1,052 URD and 3,514 MSD BMT recipients with CML in CP1.

Results: Five-year overall survival and leukemia-free survival (LFS) after receipt of BMTs from 8/8 matched URDs were worse than those after receipt of BMTs from MSDs (5-year survival, 55% v 63%; RR, 1.35; 95% CI, 1.17 to 1.56; P < .001; LFS, 50% v 55%; RR, 1.21; 95% CI, 1.06 to 1.40; P = .006). Survival was progressively worse with greater degrees of mismatch. Similar and low risk of relapse were observed after receipt of transplant from either MSD or URD.

Conclusion: In this homogeneous cohort of good risk patients with CML in CP1, 5-year overall survival and LFS after receipt of transplant from 8/8 allele-matched donors were modestly though significantly worse than those after receipt of transplant from MSDs. Additive adverse effects of multilocus mismatching are not well tolerated and should be avoided if possible.

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Conflict of interest statement

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Figures

Fig 1.
Fig 1.
(A) Probability of overall survival and (B) leukemia-free survival after receipt of bone marrow transplant. MSD, HLA-identical sibling; 8/8 matched URD, unrelated donor allele level matched at HLA-A, -B, -C, and -DRB1; 7/8 class I MM, single mismatch at antigen or allele level at HLA-A, -B, or -C; 7/8 class II MM, single mismatch at allele level at HLA-DRB1.
Fig 2.
Fig 2.
(A) Cumulative incidence of relapse and (B) treatment-related mortality after receipt of bone marrow transplant. MSD, HLA-identical sibling; 8/8 matched URD, unrelated donor allele level matched at HLA-A, -B, -C, and -DRB1; 7/8 class I MM, single mismatch at antigen or allele level at HLA-A, -B, or -C; 7/8 class II MM, single mismatch at allele level at HLA-DRB1.
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