The graft-versus-leukemia effect using matched unrelated donors is not superior to HLA-identical siblings for hematopoietic stem cell transplantation
Year: 2008
Type: article
Study design: Observational Study
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.
Source: Blood
Authors: 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, Mukta Arora
Institutions: Karolinska University Hospital, National Institutes of Health, University of South Florida, Moffitt Cancer Center, Medical College of Wisconsin, Brigham and Women's Hospital, Harvard University, Dana-Farber Cancer Institute, Dana-Farber Brigham Cancer Center, Azienda USL di Pescara, Cleveland Clinic, Columbia University Irving Medical Center, Princess Margaret Cancer Centre, Roswell Park Comprehensive Cancer Center, St. Jude Children's Research Hospital, University Hospital of Basel, Vanderbilt University Medical Center, Mayo Clinic, Policlinico San Matteo Fondazione, University of California, San Francisco, Fred Hutch Cancer Center, University of California, Los Angeles, Maastricht University Medical Centre, University Medical Center Utrecht, University of Florida, University of Minnesota
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Funders: U.S. Department of Health and Human Services, Children's Cancer Foundation, Insamlingsstiftelsen Cancer- och Allergifonden, Cancerfonden, Karolinska Institutet, Vetenskapsrådet, Cancerföreningen i Stockholm, Health Resources and Services Administration, U.S. Navy, National Heart, Lung, and Blood Institute, Office of Naval Research, National Cancer Institute, National Institute of Allergy and Infectious Diseases
OpenAlex ID: W1973248441