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Comparative Study
. 2010 Sep 16;116(11):1839-48.
doi: 10.1182/blood-2010-04-278317. Epub 2010 Jun 10.

Comparable survival after HLA-well-matched unrelated or matched sibling donor transplantation for acute myeloid leukemia in first remission with unfavorable cytogenetics at diagnosis

Vikas Gupta  1 , Martin S Tallman, Wensheng He, Brent R Logan, Edward Copelan, Robert Peter Gale, Hanna J Khoury, Thomas Klumpp, John Koreth, Hillard M Lazarus, David I Marks, Rodrigo Martino, David A Rizzieri, Jacob M Rowe, Mitchell Sabloff, Edmund K Waller, John F DiPersio, Donald W Bunjes, Daniel J Weisdorf
Affiliations
Comparative Study

Comparable survival after HLA-well-matched unrelated or matched sibling donor transplantation for acute myeloid leukemia in first remission with unfavorable cytogenetics at diagnosis

Vikas Gupta et al. Blood. .

Abstract

We compared the outcomes of unrelated donor (URD, n = 358) with human leukocyte antigen (HLA)-matched sibling donor (MSD, n = 226) transplantations in patients with acute myeloid leukemia (AML) in first complete remission (CR1) having unfavorable cytogenetics at diagnosis. Unfavorable cytogenetic abnormalities were: complex (≥ 3 abnormalities), 32%; and noncomplex involving chromosome 7, 25%; chromosome 5, 9%; 11q or MLL rearrangements, 18%; t(6;9), 5%; and other noncomplex, 10%. URDs were HLA-well-matched (n = 254; 71%) or partially-matched (n = 104; 29%). Three-year leukemia-free survival (LFS) for MSD was 42% (95% confidence interval [CI], 35%-48%) compared with 34% (95% CI, 28%-41%) for HLA-well-matched URD and 29% (95% CI, 20%-39%) for partially-matched URD (P = .08). In multivariate analysis, HLA-well-matched URD and MSD yielded similar LFS (relative risk [RR] = 1.1, 95% CI, 0.86-1.40, P = .44) and overall survival (OS; RR = 1.06, 95% CI, 0.83-1.37, P = .63). LFS and OS were significantly inferior for HLA-partially-matched URD recipients, those with prior myelodysplastic syndrome, and those older than 50 years. All cytogenetic cohorts had similar outcomes. Patients with chronic graft-versus-host disease had a significantly lower risk of relapse (RR = 0.68, 95% CI, 0.47-0.99, P = .05). Hematopoietic cell transplantation (HCT) using HLA-well-matched URD and MSD resulted in similar LFS and OS in AML patients in CR1 with unfavorable cytogenetics. Outcomes of HCT from HLA-partially- matched URD were inferior.

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Figures

Figure 1
Figure 1
Comparisons of MSD, HLA-well-matched URD, and partially-matched URD transplantation in AML patients in CR1 with unfavorable cytogenetics. (A) Cumulative incidence of TRM. (B) Cumulative incidence of relapse. (C) Adjusted probability of LFS. (D) Adjusted probability of OS.
Figure 2
Figure 2
Impact of various unfavorable cytogenetic subsets on relapse.
See this image and copyright information in PMC

Comment in

  • Transplantation in AML CR1.
    Savani BN. Savani BN. Blood. 2010 Sep 16;116(11):1822-3. doi: 10.1182/blood-2010-06-291500. Blood. 2010. PMID: 20847206 No abstract available.

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