Effectiveness of Unrelated Donor Allogeneic Hematopoietic Cell Transplantation: Results of a Donor Vs. No Donor Analysis
Year: 2012
Type: article
Study design: Observational Study
Abstract: In a consecutive series of unrelated donor searches conducted from March, 2006 through December, 2009 at Moffitt Cancer Center, we studied the following: (1) likelihood of finding a suitable (7-8/8) high-resolution matched unrelated donor; (2) factors associated with reaching transplant (HCT) among those with a donor; and (3) the effect of unrelated donor vs. no donor status on survival by intention to treat (ITT) analysis. Those with a fully HLA-A, -B, -C, and –DRB1 (8/8) matched or single locus (7/8) mismatched unrelated donor were defined as donor (n = 448), while those without were no donor (n = 83). Median time from search initiation to donor identification was 21 days; 95% of these values were within 59 days. While race/ethnicity (p<0.0001) and disease (p = 0.01) were associated with finding a donor, other variables (age, gender, CIBMTR risk, CMV, KPS, socio-economic status) were not. Among those with a donor, logistic regression modeling identified increasing age (p = 0.02), non-Caucasian race/ethnicity (p = 0.002), and high CIBMTR risk (p = 0.007) as associated with decreased odds for reaching HCT. Among 448 patients in the donor group, 239 underwent HCT. Of those in the no donor group, a total of 14 underwent double umbilical cord blood transplant (dUCBT). In the primary ITT analysis, we studied outcome according to donor vs. no donor status from time of search initiation using a time-dependent Cox model. Compared to no donor, donor status had reduced hazard for mortality (HR of 0.85, 95% CI 0.63 -1.2, p = 0.3). Accounting for interaction, those with KPS 90-100 and donor had significantly reduced hazard (HR 0.59, 95% CI 0.38 - 0.90, p = 0.02) compared to no donor. Secondary analyses examined outcome by treatment received: Those who received the intended HCT in the donor group had significantly reduced hazard (HR 0.64, 95% CI 0.46 – 0.89, p = 0.009) compared to no donor. In a separate analysis, donor, dUCBT, and no donor/no UCBT were treated as time-varying covariates, demonstrating significantly reduced hazard for donor vs. no donor (HR 0.57, 95% CI 0.43-0.76, p = 0.0001). No significant effect of matching (7/8 vs. 8/8) was detected in any analyses. In total, these data provide new insight into factors associated with unrelated donor identification according to high-resolution typing methods, identify factors relevant to reaching HCT among those with a suitable donor, and speak to the efficacy of unrelated donor HCT.
Institution: Moffitt Cancer Center
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,650
OpenAlex ID: W2005090774