Donor age and degree of HLA matching have a major impact on the outcome of unrelated donor haematopoietic cell transplantation for chronic myeloid leukaemia.
We analysed the outcome of 92 consecutive unrelated donor haematopoietic cell transplantations (UD-HCTs) performed in Spain to treat adult patients with CML in the first chronic phase (1CP). Patients' and donors' median age was 32 (15-49) and 36 (22-56) years, respectively. In all, 73 pairs (79%) matched for A, B+/-C and DRB1+/-DQB1 loci and 19 had > or =1 mismatch. Their probability of survival and disease-free survival at 4 years were 50 and 46%, respectively. Pretransplant factors associated with a better survival were patient age <25 years (P=0.035), donor age < or =36 years (P=0.012), use of cyclosporine since day -7 (P=0.001), and matching 8/8, 9/10 or 10/10 loci at allele level (P=0.003). In multivariate analysis only donor age (P=0.003; RR=3.1 (95% CI: 1.3-7.1)) and degree of HLA-matching (P=0.009; RR: 7.7 (95% CI: 1.8-33)) maintained their significance. The addition of these two variables to the EBMT prognostic score allowed an adequate risk assessment for patients receiving a UD-HCT during 1CP. Our analysis shows that in patients with a young and fully allele-matched donor, UD-HCT should be considered in the initial therapeutic algorithm due to its excellent outcome (92% survival at 2 years).
Carreras
E
E
Spanish Bone Marrow Donor Registry (REDMO), IDIBAPS, Barcelona, Spain. carreras@clinic.ub.es
Jiménez
M
M
Gómez-García
V
V
de la Cámara
R
R
Martín
C
C
Martínez
F
F
Iriondo
A
A
Sanz
G
G
Cañizo
C
C
Cabrera
R
R
Sierra
J
J
Vallejo
C
C
López
J
J
Martínez
C
C
Rovira
M
M
Fernández-Rañada
J M
JM
Torres
A
A
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D018572:Disease-Free Survival; D005260:Female; D006683:HLA-DQ Antigens; D006684:HLA-DR Antigens; D059811:HLA-DRB1 Chains; D018380:Hematopoietic Stem Cell Transplantation; D006650:Histocompatibility Testing; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000401:mortality / Q000628:therapy*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D014184:Transplantation, Homologous
D006683:HLA-DQ Antigens; C051568:HLA-DQ1 antigen; D006684:HLA-DR Antigens; D059811:HLA-DRB1 Chains