Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2016 Sep 2;9(1):79.
doi: 10.1186/s13045-016-0314-x.

Matched and mismatched unrelated donor compared to autologous stem cell transplantation for acute myeloid leukemia in first complete remission: a retrospective, propensity score-weighted analysis from the ALWP of the EBMT

Francesco Saraceni  1 , Myriam Labopin  2 , Norbert-Claude Gorin  2 , Didier Blaise  3 , Reza Tabrizi  4 , Liisa Volin  5 , Jan Cornelissen  6 , Jean-Yves Cahn  7 , Patrice Chevallier  8 , Charles Craddock  9 , Depei Wu  10 , Anne Huynh  11 , William Arcese  12 , Mohamad Mohty  2 , Arnon Nagler  13   14 ; Acute Leukemia Working Party (ALWP) of the European society for Blood and Marrow Transplantation (EBMT)
Affiliations
Comparative Study

Matched and mismatched unrelated donor compared to autologous stem cell transplantation for acute myeloid leukemia in first complete remission: a retrospective, propensity score-weighted analysis from the ALWP of the EBMT

Francesco Saraceni et al. J Hematol Oncol. .

Abstract

Background: Optimal post-remission strategy for patients with acute myeloid leukemia (AML) is matter of intense debate. Recent reports have shown stronger anti-leukemic activity but similar survival for allogeneic stem cell transplantation (allo-HSCT) from matched sibling donor compared to autologous transplantation (auto-HSCT); however, there is scarcity of literature confronting auto-HSCT with allo-HSCT from unrelated donor (UD-HSCT), especially mismatched UD-HSCT.

Methods: We retrospectively compared outcome of allogeneic transplantation from matched (10/10 UD-HSCT) or mismatched at a single HLA-locus unrelated donor (9/10 UD-HSCT) to autologous transplantation in patients with AML in first complete remission (CR1). A total of 2879 patients were included; 1202 patients received auto-HSCT, 1302 10/10 UD-HSCT, and 375 9/10 UD-HSCT. A propensity score-weighted analysis was conducted to control for disease risk imbalances between the groups.

Results: Matched 10/10 UD-HSCT was associated with the best leukemia-free survival (10/10 UD-HSCT vs auto-HSCT: HR 0.7, p = 0.0016). Leukemia-free survival was not statistically different between auto-HSCT and 9/10 UD-HSCT (9/10 UD-HSCT vs auto-HSCT: HR 0.8, p = 0.2). Overall survival was similar across the groups (10/10 UD-HSCT vs auto-HSCT: HR 0.98, p = 0.84; 9/10 UD-HSCT vs auto-HSCT: HR 1.1, p = 0.49). Notably, in intermediate-risk patients, OS was significantly worse for 9/10 UD-HSCT (9/10 UD-HSCT vs auto-HSCT: HR 1.6, p = 0.049), while it did not differ between auto-HSCT and 10/10 UD-HSCT (HR 0.95, p = 0.88). In favorable risk patients, auto-HSCT resulted in 3-year LFS and OS rates of 59 and 78 %, respectively.

Conclusions: Our findings suggest that in AML patients in CR1 lacking an HLA-matched sibling donor, 10/10 UD-HSCT significantly improves LFS, but this advantage does not translate in better OS compared to auto-HSCT. In intermediate-risk patients lacking a fully HLA-matched donor, auto-HSCT should be considered as a valid option, as better survival appears to be provided by auto-HSCT compared to mismatched UD-HSCT. Finally, auto-HSCT provided an encouraging outcome in patients with favorable risk AML.

Keywords: Acute myeloid leukemia (AML); Allogeneic transplantation; Autologous transplantation; Matched (10/10) and mismatched (9/10) unrelated donor transplantation; Post-remission therapy.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Outcome by type of transplant in the global population. The cumulative incidence of non-relapse mortality (a) and relapse (b) by transplant type; the probability of leukemia-free survival (c) and overall survival (d) in the global population. Kaplan-Meier curves and Cox analysis are weighted for propensity score; Cox analysis is further adjusted for kind of conditioning and stem cell source
Fig. 2
Fig. 2
Leukemia-free survival and overall survival by type of transplant in good-risk patients. The probability of leukemia-free survival (a) and overall survival (b) in good-risk patients
Fig. 3
Fig. 3
Leukemia-free survival and overall survival by type of transplant in intermediate-risk patients. The probability of leukemia-free survival (a) and overall survival (b) in intermediate-risk patients
Fig. 4
Fig. 4
Leukemia-free survival and overall survival by type of transplant in poor-risk patients. The probability of leukemia-free survival (a) and overall survival (b) in poor-risk patients
See this image and copyright information in PMC

References

    1. Schlenk RF, Döhner K, Mack S, Stoppel M, Király F, Götze K, et al. Prospective evaluation of allogeneic hematopoietic stem-cell transplantation from matched related and matched unrelated donors in younger adults with high-risk acute myeloid leukemia: German-Austrian trial AMLHD98A. J Clin Oncol. 2010;28(30):4642–8. doi: 10.1200/JCO.2010.28.6856. - DOI - PubMed
    1. Verneris MR, Lee SJ, Ahn KW, Wang HL, Battiwalla M, Inamoto Y, et al. HLA mismatch is associated with worse outcomes after unrelated donor reduced-intensity conditioning hematopoietic cell transplantation: an analysis from the center for international blood and marrow transplant research. Biol Blood Marrow Transplant. 2015;21(10):1783–9. doi: 10.1016/j.bbmt.2015.05.028. - DOI - PMC - PubMed
    1. Gorin NC, Najman A, Duhamel G. Autologous bone-marrow transplantation in acute myelocytic leukaemia. Lancet. 1977;1(8020):1050. doi: 10.1016/S0140-6736(77)91275-2. - DOI - PubMed
    1. Savani BN, Labopin M, Kröger N, Finke J, Ehninger G, Niederwieser D, et al. Expanding transplant options to patients over 50 years—improved outcome after reduced intensity conditioning mismatched-unrelated donor transplantation for patients with acute myeloid leukemia: a report from the Acute Leukemia Working Party of the EBMT. Haematologica. 2016;101(6):773–80. doi: 10.3324/haematol.2015.138180. - DOI - PMC - PubMed
    1. Kanakry CG, O’Donnell PV, Furlong T, de Lima MJ, Wei W, Medeot M, et al. Multi-institutional study of post-transplantation cyclophosphamide as single-agent graft-versus-host disease prophylaxis after allogeneic bone marrow transplantation using myeloablative busulfan and fludarabine conditioning. J Clin Oncol. 2014;32(31):3497–505. doi: 10.1200/JCO.2013.54.0625. - DOI - PMC - PubMed

MeSH terms