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The graft-versus-leukemia effect using matched unrelated donors is not superior to HLA-identical siblings for hematopoietic stem cell transplantation

By Olle Ringdén, Steven Z. Pavletic, Claudio Anasetti, A. John Barrett, Tao Wang, Dan Wang, Joseph H. Antin, Paolo Di Bartolomeo, Brian J. Bolwell, Christopher Bredeson, Mitchell S. Cairo, Robert P. Gale, Vikas Gupta, Theresa Hahn, Gregory A. Hale, Jorg Halter, Madan Jagasia, Mark R. Litzow, Franco Locatelli, David I. Marks, Philip L. McCarthy, Morton J. Cowan, Effie W. Petersdorf, James A. Russell, Gary J. Schiller, Harry Schouten, Stephen Spellman, Leo F. Verdonck, John R. Wingard, Mary M. Horowitz and Mukta Arora

Abstract

Do some patients benefit from an unrelated donor (URD) transplant because of a stronger graft-versus-leukemia (GVL) effect? We analyzed 4099 patients with acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), and chronic myeloid leukemia (CML) undergoing a myeloablative allogeneic hematopoietic cell transplantation (HCT) from an URD (8/8 human leukocyte antigen [HLA]–matched, n = 941) or HLA-identical sibling donor (n = 3158) between 1995 and 2004 reported to the CIBMTR. In the Cox regression model, acute and chronic GVHD were added as time-dependent variables. In multivariate analysis, URD transplant recipients had a higher risk for transplantation-related mortality (TRM; relative risk [RR], 2.76; P < .001) and relapse (RR, 1.50; P < .002) in patients with AML, but not ALL or CML. Chronic GVHD was associated with a lower relapse risk in all diagnoses. Leukemia-free survival (LFS) was decreased in patients with AML without acute GVHD receiving a URD transplant (RR, 2.02; P < .001) but was comparable to those receiving HLA-identical sibling transplants in patients with ALL and CML. In patients without GVHD, multivariate analysis showed similar risk of relapse but decreased LFS for URD transplants for all 3 diagnoses. In conclusion, risk of relapse was the same (ALL, CML) or worse (AML) in URD transplant recipients compared with HLA-identical sibling transplant recipients, suggesting a similar GVL effect

Topics: Transplantation
Publisher: American Society of Hematology
OAI identifier: oai:pubmedcentral.nih.gov:2662650
Provided by: PubMed Central
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