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Biol Blood Marrow Transplant. 2019 Jul 1. pii: S1083-8791(19)30415-X. doi: 10.1016/j.bbmt.2019.06.031. [Epub ahead of print]

Comparable Long-Term Outcome after Allogeneic Stem-Cell Transplantation from Sibling and Matched Unrelated Donors in AML Patients Older than 50 years. A Report on Behalf of the ALWP of EBMT.

Author information

1
Chaim Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, Israel. Electronic address: avichai.shimoni@sheba.health.gov.il.
2
Acute leukemia working party office, Paris.
3
Vanderbilt University Hematology & Transplantation, Nashville, United States.
4
HUCH Comprehensive Cancer Center, Stem Cell Transplantation Unit, Helsinki.
5
University of Freiburg, Dept. of Medicine -Hematology, Oncology, Freiburg.
6
University Hospital Leipzig, Division of Haematology & Oncology, Leipzig.
7
Universitaetsklinikum Dresden, Medizinische Klinik und Poliklinik I, Dresden.
8
Programme de Transplantation & Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France.
9
University Hospital, Dept. of Bone Marrow Transplantation, Essen, Germany.
10
CHU Bordeaux, Hôpital Haut-leveque, Pessac, France.
11
Bone Marrow Transplant Unit L 4043, National University Hospital, Copenhagen.
12
Hannover Medical School, Department of Haematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover, Germany.
13
Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Hematology, Rotterdam, The Netherlands.
14
Service d'Hématologie et de Thérapie cellulaire, Hôpital Saint-Antoine, Paris, France.
15
Chaim Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, Israel; Acute leukemia working party office, Paris.

Abstract

Allogeneic stem-cell transplantation (SCT) is potentially curative therapy in acute myeloid leukemia (AML). Marked improvement has been achieved with SCT from matched unrelated-donors (MUD) in recent years. However, there is limited data comparing the long-term outcomes (beyond 10 years) after SCT from sibling donors and MUDs in older AML patients. We analyzed these outcomes in a large cohort of AML patients (n=1134), age ≥50 years, who were alive and leukemia-free 2 years after SCT from matched siblings (n=848) or MUD (n=286), with a median follow up 8.9 years. The median age was 56 and 58 years, after SCT from sibling and MUDs, respectively (P=0.005). 77%, 12% and 11% in the sibling group were in CR1, CR2 and active leukemia at SCT compared to 50%, 25% and 25% in the MUD group, respectively (P<0.001). 61% of sibling, and 62% of MUDs had reduced-intensity conditioning (P=0.78). The 10-year leukemia-free survival (LFS) of patients surviving leukemia-free 2 years after SCT was 72% and 62%, respectively (P=0.30). Multivariate-analysis identified active leukemia at SCT (HR 1.86, P=0.0001) or CR2 (HR 1.51, P=0.02) compared to CR1, female recipient (HR 0.71, P=0.006), adverse cytogenetics (HR 2.52, P=0.01) and prior GVHD (HR 1.31, P=0.04) as independent factors predicting LFS. Donor and conditioning type were not significant. The cumulative incidence of late relapse was 15% and 17% (P=0.97) and of late non-relapse mortality, 13% and 21%, respectively (P=0.15). Long-term LFS is similar and patients who are leukemia-free 2 years after SCT can expect favorable outcomes with both donor types.

KEYWORDS:

Acute myeloid leukemia; allogeneic stem cell transplantation; long-term outcome; sibling; unrelated donor

PMID:
31271887
DOI:
10.1016/j.bbmt.2019.06.031

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