Comparison of matched sibling donors versus unrelated donors in allogeneic stem cell transplantation for primary refractory acute myeloid leukemia: A study on behalf of the Acute Leukemia Working Party of the EBMT

Eolia Brissot, Myriam Labopin, Matthias Stelljes, Gerhard Ehninger, Rainer Schwerdtfeger, Jürgen Finke, Hans Jochem Kolb, Arnold Ganser, Kerstin Schäfer-Eckart, Axel R. Zander, Donald Bunjes, Stephan Mielke, Wolfgang A. Bethge, Noël Milpied, Peter Kalhs, Igor Woflgang Blau, Nicolaus Kröger, Antonin Vitek, Martin Gramatzki, Ernst HollerChristoph Schmid, Jordi Esteve, Mohamad Mohty, Arnon Nagler

Publikation: Beitrag in FachzeitschriftArtikelBegutachtung

34 Zitate (Scopus)

Abstract

Background: Primary refractory acute myeloid leukemia (PRF-AML) is associated with a dismal prognosis. Allogeneic stem cell transplantation (HSCT) in active disease is an alternative therapeutic strategy. The increased availability of unrelated donors together with the significant reduction in transplant-related mortality in recent years have opened the possibility for transplantation to a larger number of patients with PRF-AML. Moreover, transplant from unrelated donors may be associated with stronger graft-mediated anti-leukemic effect in comparison to transplantations from HLA-matched sibling donor, which may be of importance in the setting of PRF-AML. Methods: The current study aimed to address the issue of HSCT for PRF-AML and to compare the outcomes of HSCT from matched sibling donors (n = 660) versus unrelated donors (n = 381), for patients with PRF-AML between 2000 and 2013. The Kaplan-Meier estimator, the cumulative incidence function, and Cox proportional hazards regression models were used where appropriate. Results: HSCT provide patients with PRF-AML a 2-year leukemia-free survival and overall survival of about 25 and 30%, respectively. In multivariate analysis, two predictive factors, cytogenetics and time from diagnosis to transplant, were associated with lower leukemia-free survival, whereas Karnofsky performance status at transplant ≥90% was associated with better leukemia-free survival (LFS). Concerning relapse incidence, cytogenetics and time from diagnosis to transplant were associated with increased relapse. Reduced intensity conditioning regimen was the only factor associated with lower non-relapse mortality. Conclusions: HSCT was able to rescue about one quarter of the patients with PRF-AML. The donor type did not have any impact on PRF patients' outcomes. In contrast, time to transplant was a major prognostic factor for LFS. For patients with PRF-AML who do not have a matched sibling donor, HSCT from an unrelated donor is a suitable option, and therefore, initiation of an early search for allocating a suitable donor is indicated.

OriginalspracheEnglisch
Aufsatznummer130
FachzeitschriftJournal of Hematology and Oncology
Jahrgang10
Ausgabenummer1
DOIs
PublikationsstatusVeröffentlicht - 24 Juni 2017
Extern publiziertJa

Fingerprint

Untersuchen Sie die Forschungsthemen von „Comparison of matched sibling donors versus unrelated donors in allogeneic stem cell transplantation for primary refractory acute myeloid leukemia: A study on behalf of the Acute Leukemia Working Party of the EBMT“. Zusammen bilden sie einen einzigartigen Fingerprint.

Dieses zitieren