Citations 1
The graft-versus-leukemia effect using matched unrelated donors is not superior to HLA-identical siblings for hematopoietic stem cell transplantation
Ringdén, Olle , Pavletic, Steven Z. , Anasetti, Claudio , Wang, Tao , Antin, Joseph H. , Bartolomeo, Paolo Di , Bolwell, Brian J., Bredeson, Christopher , Cairo, Mitchell S. , Gupta, Vikas , Hahn, Theresa , Hale, Gregory A., Halter, Jörg , Jagasia, Madan , Litzow, Mark R. , Marks, David I. , Cowan, Morton J. , Petersdorf, Effie W. , Russell, James A. , Schiller, Gary J. , Schouten, Harry C. , Verdonck, Leo F. , Horowitz, Mary M. , Arora, Mukta , Barrett, A. John , Wang, Dan , Gale, Robert Peter , Locatelli, Franco , McCarthy, Philip L. , Spellman, Stephen R. , Wingard, John R. , Halter, Joerg , Ringden, Olov , Gupta, Vikas
Blood | December 5, 2008 | Volume: 113 | Issue: 13 | Pages: 3110-3118
AbstractDo 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.