Autotransplantation versus HLA-matched unrelated donor transplantation for acute myeloid leukaemia: a retrospective analysis from the Center for International Blood and Marrow Transplant Research.
Most acute myeloid leukaemia (AML) patients lack human leucocyte antigen-identical sibling donors for transplantation. Autotransplants and unrelated donor (URD) transplants are therapeutic options. To compare autologous versus URD transplantation for AML in first (CR1) or second complete remission (CR2), we studied the outcomes of 668 autotransplants were compared with 476 URD transplants reported to the Center for International Blood and Marrow Transplant Research. Proportional hazards regression adjusted for differences in prognostic variables. In multivariate analyses transplant-related mortality (TRM) was significantly higher and relapse lower with URD transplantation. Adjusted 3-year survival probabilities were: in CR1 57 (53-61)% with autotransplants and 44 (37-51)% URD (P = 0.002), in CR2 46 (39-53)% and 33 (28-38)% respectively (P = 0.006). Adjusted 3-year leukaemia-free survival (LFS) probabilities were: CR1 53 (48-57)% with autotransplants and 43 (36-50)% with URD (P = 0.021), CR2 39 (32-46)% and 33 (27-38)% respectively (P = 0.169). Both autologous and URD transplantation produced prolonged LFS. High TRM offsets the superior antileukaemia effect of URD transplantation. This retrospective, observational database study showed that autotransplantation, in general, offered higher 3-year survival for AML patients in CR1 and CR2. Cytogenetics, however, were known in only two-thirds of patients and treatment bias cannot be eliminated.
Lazarus
Hillard M
HM
University Hospitals of Cleveland, Ireland Cancer Center, Cleveland, OH, USA.
Pérez
Waleska S
WS
Klein
John P
JP
Kollman
Craig
C
Bate-Boyle
B
B
Bredeson
Christopher N
CN
Gale
Robert Peter
RP
Geller
Robert B
RB
Keating
Armand
A
Litzow
Mark R
MR
Marks
David I
DI
Miller
Carole B
CB
Douglas Rizzo
J
J
Spitzer
Thomas R
TR
Weisdorf
Daniel J
DJ
Zhang
Mei-Jie
MJ
Horowitz
Mary M
MM
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000379:methods*; D002648:Child; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006650:Histocompatibility Testing / Q000379:methods; D006801:Humans; D007951:Leukemia, Myeloid / Q000401:mortality / Q000601:surgery*; D008297:Male; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies; D016019:Survival Analysis; D014182:Transplantation, Autologous / Q000379:methods; D014184:Transplantation, Homologous / Q000379:methods; D016896:Treatment Outcome