Donor search or autografting in patients with acute leukaemia who lack an HLA-identical sibling? A matched-pair analysis

O. Ringdén, M. Labopin, E. Gluckman, J. M. Hows, B. A. Bradley, H. J. Kolb, L. Fouillard, N. Jacobsen, J. P. Vernant, F. Witz, J. L. Harousseau, N. C. Gorin

Research output: Contribution to journalArticlepeer-review

38 Scopus citations

Abstract

One hundred and ninety-one patients with acute leukaemia who received bone marrow from HLA-A, -B and -DR identical unrelated donors and were reported to EBMT and/or IMUST, were matched with 382 patients receiving autologous bone marrow for diagnosis, age, stage of disease and year of transplantation. Transplant-related mortality (TRM) was significantly higher in recipients of unrelated marrow compared to autograft recipients, 44 ± 4% (± 95% confidence interval) and 15 ± 3% at 2 years in the two groups, respectively (P < 10-4). In contrast, relapse probability was lower in recipients of unrelated marrow, being 32 ± 5% at 2 years compared to 55 ± 3% in recipients of autografts (P < 10-4). Two-year leukaemia-free survival (LFS) in patients with acute lymphoblastic leukaemia was 39 ± 5% and 32 ± 3% in the two groups, respectively. Among patients with acute myeloid leukaemia (AML), the corresponding figures were 36 ± 6% and 46 ± 5% in the two groups, respectively (P = NS). In AML in first remission (CR-1), the 2-year survival was 42 ± 10% in recipients of unrelated bone marrow, compared to 69 ± 8% in autograft recipients (P = 0.008). When all patients with acute leukaemia were included, the 2-year LFS was 38% in recipients of unrelated marrow, compared to 37% in autograft recipients (NS). In conclusion, this retrospective analysis supports the design of a prospective randomized study in patients with high-risk/advanced acute leukaemia who lack a suitable related bone marrow donor, to ascertain which of the two strategies, if any, should be favoured.

Original languageEnglish
Pages (from-to)963-968
Number of pages6
JournalBone Marrow Transplantation
Volume19
Issue number10
DOIs
StatePublished - 2 May 1997
Externally publishedYes

Keywords

  • Acute lymphoblastic leukaemia
  • Acute myeloid leukaemia
  • Autografting
  • Bone marrow transplant
  • Unrelated donors

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