title: Donor search or autografting in patients with acute leukaemia who lack an HLA-identical sibling? A matched-pair analysis. Acute Leukaemia Working Party of the European Cooperative Group for Blood and Marrow Transplantation (EBMT) and the International Marrow Unrelated Search and Transplant (IMUST) Study.
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.
authors.affiliation: Dept of Clinical Immunology, Huddinge Hospital, Sweden.
authors.forename: O
authors.initials: O
authors.lastname: Ringdén
authors.forename: M
authors.initials: M
authors.lastname: Labopin
authors.forename: E
authors.initials: E
authors.lastname: Gluckman
authors.forename: J M
authors.initials: JM
authors.lastname: Hows
authors.forename: B A
authors.initials: BA
authors.lastname: Bradley
authors.forename: H J
authors.initials: HJ
authors.lastname: Kolb
authors.forename: L
authors.initials: L
authors.lastname: Fouillard
authors.forename: N
authors.initials: N
authors.lastname: Jacobsen
authors.forename: J P
authors.initials: JP
authors.lastname: Vernant
authors.forename: F
authors.initials: F
authors.lastname: Witz
authors.forename: J L
authors.initials: JL
authors.lastname: Harousseau
authors.forename: N C
authors.initials: NC
authors.lastname: Gorin
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000276:immunology / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005260:Female; D006680:HLA Antigens; D006801:Humans; D007223:Infant; D007938:Leukemia / Q000401:mortality / Q000628:therapy*; D015470:Leukemia, Myeloid, Acute / Q000401:mortality / Q000628:therapy; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D015996:Survival Rate; D009927:Tissue and Organ Procurement; D014182:Transplantation, Autologous
chemical_list: D006680:HLA Antigens