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Haematologica. 2019 May 17. pii: haematol.2018.215202. doi: 10.3324/haematol.2018.215202. [Epub ahead of print]

Alternative donor transplantation for acute myeloid leukemia in patients aged ≥50 years: young HLA-matched unrelated or haploidentical Donor?

Author information

1
Department of Medicine, Memorial Sloan Kettering Cancer Center, USA.
2
Case Western Reserve University.
3
Medical College of Wisconsin, Milwaukee, WI, USA.
4
Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
5
University of Miami.
6
Institute of Haematology, Royal Prince Alfred Hospital, Camperdown, NSW.
7
Bone Marrow Transplant Program, Mayo Clinic, Rochester, MN, Australia.
8
Blood and Marrow Transplant Program, The Ottawa Hospital, Ottawa, ON, Canada.
9
Case Western Reserve University, Cleveland, OH, USA.
10
University Hospitals Bristol National Health Service Foundation Trust, Bristol, UK.
11
University of Kansas Medical Center, Kansas City, KS, USA.
12
Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
13
The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA.
14
BMT Program, University of Minnesota Masonic Children Hospital, Minneapolis, MN, USA.
15
University of Minnesota Medical Center, Minneapolis, MN, USA.
16
Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA; meapen@mcw.edu.

Abstract

We sought to study whether survival after haplo-identical transplantation is comparable to that after matched unrelated donor transplantation for 822 patients aged 50-75 years with acute myeloid leukemia in first or second complete remission. One hundred and ninety-two patients received grafts from haplo-identical donors (sibling 25%; offspring 75%) and 631 patients from matched unrelated donors aged 18-40 years. Patient and disease characteristics of the two groups were similar except recipients of matched unrelated donor transplantation were more likely to have poor risk cytogenetics and more likely to receive myeloablative conditioning regimens. Time from documented remission to transplant did not differ by donor type. Five-year overall survival was 32% and 42% after haplo-identical and matched unrelated donor transplant, respectively (p-value=0.1). Multivariable analysis showed higher mortality (hazard ratio 1.27, p-value=0.04) and relapse (hazard ratio 1.32, p-value=0.04) after haplo-identical transplantation, with similar non-relapse mortality risks. Chronic graft-versus-host disease was higher after matched unrelated donor compared to haplo-identical transplantation when bone marrow was the graft (hazard ratio 3.12, p-value<0.001), but when the graft was peripheral blood the risk of chronic graft-versus-host disease did not differ by donor type. These data support matched unrelated donor transplant with donors younger than 40 years is preferred.

KEYWORDS:

Acute Myeloid Leukemia; Alternative donor; Hematopoietic Stem Cell; Stem Cell Transplantation

PMID:
31101756
DOI:
10.3324/haematol.2018.215202
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