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Comparative Study
. 2017 Sep 1;123(17):3346-3355.
doi: 10.1002/cncr.30737. Epub 2017 Apr 27.

Comparing outcomes of matched related donor and matched unrelated donor hematopoietic cell transplants in adults with B-Cell acute lymphoblastic leukemia

Eric Segal  1 , Michael Martens  2 , Hai-Lin Wang  3 , Ruta Brazauskas  2 , Daniel Weisdorf  4 , Brenda M Sandmaier  5 , H Jean Khoury  6 , Marcos de Lima  7 , Wael Saber  3
Affiliations
Comparative Study

Comparing outcomes of matched related donor and matched unrelated donor hematopoietic cell transplants in adults with B-Cell acute lymphoblastic leukemia

Eric Segal et al. Cancer. .

Abstract

Background: Allogeneic hematopoietic cell transplantation (HCT) using human leukocyte antigen (HLA)-matched related donors (RDs) and allogeneic HCT using HLA-matched unrelated donors (URDs) produce similar outcomes for patients with acute myelogenous leukemia, whereas the donor source has been reported to be a predictor of outcomes in myelodysplastic syndrome.

Methods: Post-HCT outcomes for 1458 acute lymphoblastic leukemia patients from 2000 to 2011 were analyzed, and RD and URD transplants were compared.

Results: The median age was 37 years (range, 18-69 years). In the multivariate analysis, HLA 8/8 allele-matched URD recipients had similar transplant-related mortality (TRM) and all-cause mortality in comparison with RD recipients (hazard ratios [HRs], 1.16 [95% confidence interval (CI), 0.91-1.48] and 1.01 [95% CI, 0.85-1.19], respectively); 7/8 URD recipients had a greater risk of TRM and all-cause mortality in comparison with RD recipients (HRs, 1.92 [95% CI, 1.47-2.52] and 1.29 [95% CI, 1.05-1.58], respectively). The risk of TRM and all-cause mortality was also greater for 7/8 URD recipients versus 8/8 URD recipients. Compared with RD recipients, both 8/8 and 7/8 URD recipients had a lower risk of relapse (HRs, 0.77 [95% CI, 0.62-0.97] and 0.75 [95% CI, 0.56-1.00], respectively). Both 8/8 and 7/8 URD recipients had a greater risk of acute graft-versus-host disease (GVHD; HRs, 2.18 [95% CI, 1.76-2.70] and 2.65 [95% CI, 2.06-3.42], respectively) and chronic GVHD (HRs, 1.28 [95% CI, 1.06-1.55] and 1.46 [95% CI, 1.14-1.88], respectively) in comparison with RD recipients.

Conclusions: In the absence of RD transplantation, 8/8 URD transplantation is a viable alternative with similar survival outcomes, whereas 7/8 URD transplantation is associated with poorer overall survival. Cancer 2017;123:3346-55. © 2017 American Cancer Society.

Keywords: acute lymphoblastic leukemia (ALL); allogeneic transplantation; human leukocyte antigen (HLA) match; related donors; stem cell transplantation; unrelated donors.

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Conflict of interest statement

Conflict of interest disclosure: The authors declare no competing financial interests.

Figures

Figure 1
Figure 1. Adjusted probability of overall survival in adult ALL patients by donor source
In multivariate analysis, 7/8 URD recipients had significantly greater risk of mortality compared to RD and 8/8 URD recipients (HR 1.29, p=0.01 and HR 1.28, p=0.008, respectively), while there was no difference in risk comparing RD and 8/8 URD (HR 1.01, p=0.93).
Figure 2
Figure 2. Adjusted probability of leukemia-free survival in adult ALL patients by donor source
In multivariate analysis, 8/8 URD and 7/8 URD recipients had no difference in risk of treatment failure compared to RD recipients (HR 0.95, p=0.55 and HR 1.20, p=0.07) respectively. 7/8 URD had greater risk than 8/8 URD (HR 1.26, p=0.01).
See this image and copyright information in PMC

References

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