HLA-identical sibling compared with 8/8 matched and mismatched unrelated donor bone marrow transplant for chronic phase chronic myeloid leukemia. J Clin Oncol 2009 Apr 01;27(10):1644-52
Date
02/20/2009Pubmed ID
19224849Pubmed Central ID
PMC2668970DOI
10.1200/JCO.2008.18.7740Scopus ID
2-s2.0-63749113237 (requires institutional sign-in at Scopus site) 91 CitationsAbstract
PURPOSE: Transplantation of hematopoietic stem cells from an unrelated donor (URD) is an option for many patients who do not have an HLA-identical sibling donor (MSD). Current criteria for the selection of URDs include consideration for HLA alleles determined by high resolution typing methods, with preference for allele-matched donors. However, the utility and outcome associated with transplants from URDs compared with those from MSDs remains undefined.
PATIENTS AND METHODS: We examined clinical outcome after patients received bone marrow transplants (BMTs) from MSDs; HLA-A, -B, -C, and DRB1 allele-matched URDs (8/8); and HLA-mismatched URDs in a homogeneous population of patients with chronic myeloid leukemia (CML) in first chronic phase (CP1) where a strong allogeneic effect and hence a lower risk of relapse is anticipated. Transplantation outcomes were compared between 1,052 URD and 3,514 MSD BMT recipients with CML in CP1.
RESULTS: Five-year overall survival and leukemia-free survival (LFS) after receipt of BMTs from 8/8 matched URDs were worse than those after receipt of BMTs from MSDs (5-year survival, 55% v 63%; RR, 1.35; 95% CI, 1.17 to 1.56; P < .001; LFS, 50% v 55%; RR, 1.21; 95% CI, 1.06 to 1.40; P = .006). Survival was progressively worse with greater degrees of mismatch. Similar and low risk of relapse were observed after receipt of transplant from either MSD or URD.
CONCLUSION: In this homogeneous cohort of good risk patients with CML in CP1, 5-year overall survival and LFS after receipt of transplant from 8/8 allele-matched donors were modestly though significantly worse than those after receipt of transplant from MSDs. Additive adverse effects of multilocus mismatching are not well tolerated and should be avoided if possible.
Author List
Arora M, Weisdorf DJ, Spellman SR, Haagenson MD, Klein JP, Hurley CK, Selby GB, Antin JH, Kernan NA, Kollman C, Nademanee A, McGlave P, Horowitz MM, Petersdorf EWAuthor
Mary M. Horowitz MD, MS Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentAdult
Aged
Bone Marrow Transplantation
Child
Child, Preschool
Disease-Free Survival
Female
Graft vs Host Disease
Histocompatibility Antigens Class I
Humans
Kaplan-Meier Estimate
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Male
Middle Aged
Siblings
Tissue Donors
Treatment Outcome
