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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.


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.

SUBMITTER: Ringden O 

PROVIDER: S-EPMC2662650 | biostudies-literature | 2009 Mar

REPOSITORIES: biostudies-literature

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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.

Ringdén Olle O   Pavletic Steven Z SZ   Anasetti Claudio C   Barrett A John AJ   Wang Tao T   Wang Dan D   Antin Joseph H JH   Di Bartolomeo Paolo P   Bolwell Brian J BJ   Bredeson Christopher C   Cairo Mitchell S MS   Gale Robert P RP   Gupta Vikas V   Hahn Theresa T   Hale Gregory A GA   Halter Jorg J   Jagasia Madan M   Litzow Mark R MR   Locatelli Franco F   Marks David I DI   McCarthy Philip L PL   Cowan Morton J MJ   Petersdorf Effie W EW   Russell James A JA   Schiller Gary J GJ   Schouten Harry H   Spellman Stephen S   Verdonck Leo F LF   Wingard John R JR   Horowitz Mary M MM   Arora Mukta M  

Blood 20081204 13


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 regre  ...[more]

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