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. 2014 Jun;20(6):816-22.
doi: 10.1016/j.bbmt.2014.02.020. Epub 2014 Feb 26.

Alternative donor transplantation for older patients with acute myeloid leukemia in first complete remission: a center for international blood and marrow transplant research-eurocord analysis

Daniel Weisdorf  1 , Mary Eapen  2 , Annalisa Ruggeri  3 , Mei-Jie Zhang  4 , Xiaobo Zhong  5 , Claudio Brunstein  6 , Celalettin Ustun  6 , Vanderson Rocha  7 , Eliane Gluckman  8
Affiliations

Alternative donor transplantation for older patients with acute myeloid leukemia in first complete remission: a center for international blood and marrow transplant research-eurocord analysis

Daniel Weisdorf et al. Biol Blood Marrow Transplant. 2014 Jun.

Abstract

We studied patients with acute myeloid leukemia (AML) over age 50 and in first complete remission (CR1) after adult unrelated donor (URD) (n = 441, 8/8 HLA matched; n = 94, 7/8 HLA matched) or umbilical cord blood (UCB; n = 205) transplantations. UCB recipients achieved CR1 within 8 weeks less often, and received reduced-intensity conditioning and cyclosporine-based graft-versus-host disease (GVHD) prophylaxis more often. Neutrophil recovery was slower in UCB (69% by day 28) compared with 8/8 HLA-matched URD (97%) and 7/8 HLA-matched (91%) (P < .001) recipients. Three-year transplantation-related mortality (TRM) was higher and leukemia-free survival (LFS) lower with UCB (35% and 28%, respectively) versus 8/8 HLA-matched URD (27% and 39%, respectively). TRM was higher in 7/8 HLA-matched URD (41%, P = .01), but LFS was similar at 34% (P = .39). Three-year chronic GVHD was the lowest in UCB (28%) versus 53% and 59% in 8/8 and 7/8 HLA-matched URD recipients, respectively. Three-year survival was 43% in 8/8 HLA-matched URD (95% confidence interval [CI], 38% to 48%), 30% in UCB (95% CI, 23% to 37%) (P = .002) and 37% in 7/8 URD (95% CI, 27 to 46). Allotransplantation for AML in CR1 with any of these grafts extends LFS for over one third of older patients. In the absence of an 8/8 HLA-matched URD or when transplantation is needed urgently, UCB can provide extended survival. Less frequent chronic GVHD with UCB transplantation may be of particular value for older patients.

Keywords: Acute myeloid leukemia; Allogeneic transplantation; Umbilical cord blood; Unrelated donors.

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Figures

FIGURE
FIGURE
Treatment related mortality (*compared to 8/8 URD p<0.0001 within 3 months of HCT; compared to 7/8 URD p<0.001 beyond 3 months), LFS, Relapse incidence and Survival following allogeneic HCT. Adjusted p values reflect the multivariate analyses shown in Table 3. * indicates p<0.0005 compared to 8/8 URD
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