The graft-versus-leukemia effect using matched unrelated donors is not superior to HLA-identical siblings for hematopoietic stem cell transplantation.
Do some patients benefit from an unrelated donor (URD) transplant because of a stronger graft-versus-leukemia (GVL) effect? We analyzed 4099 patients with acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), and chronic myeloid leukemia (CML) undergoing a myeloablative allogeneic hematopoietic cell transplantation (HCT) from an URD (8/8 human leukocyte antigen [HLA]-matched, n=941) or HLA-identical sibling donor (n=3158) between 1995 and 2004 reported to the CIBMTR. In the Cox regression model, acute and chronic GVHD were added as time-dependent variables. In multivariate analysis, URD transplant recipients had a higher risk for transplantation-related mortality (TRM; relative risk [RR], 2.76; P< .001) and relapse (RR, 1.50; P< .002) in patients with AML, but not ALL or CML. Chronic GVHD was associated with a lower relapse risk in all diagnoses. Leukemia-free survival (LFS) was decreased in patients with AML without acute GVHD receiving a URD transplant (RR, 2.02; P< .001) but was comparable to those receiving HLA-identical sibling transplants in patients with ALL and CML. In patients without GVHD, multivariate analysis showed similar risk of relapse but decreased LFS for URD transplants for all 3 diagnoses. In conclusion, risk of relapse was the same (ALL, CML) or worse (AML) in URD transplant recipients compared with HLA-identical sibling transplant recipients, suggesting a similar GVL effect.
Ringdén
Olle
O
Center for Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Stockholm, Sweden. Olle.Ringden@ki.se
Pavletic
Steven Z
SZ
Anasetti
Claudio
C
Barrett
A John
AJ
Wang
Tao
T
Wang
Dan
D
Antin
Joseph H
JH
Di Bartolomeo
Paolo
P
Bolwell
Brian J
BJ
Bredeson
Christopher
C
Cairo
Mitchell S
MS
Gale
Robert P
RP
Gupta
Vikas
V
Hahn
Theresa
T
Hale
Gregory A
GA
Halter
Jorg
J
Jagasia
Madan
M
Litzow
Mark R
MR
Locatelli
Franco
F
Marks
David I
DI
McCarthy
Philip L
PL
Cowan
Morton J
MJ
Petersdorf
Effie W
EW
Russell
James A
JA
Schiller
Gary J
GJ
Schouten
Harry
H
Spellman
Stephen
S
Verdonck
Leo F
LF
Wingard
John R
JR
Horowitz
Mary M
MM
Arora
Mukta
M
D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000453:epidemiology; D020544:Graft vs Leukemia Effect / Q000276:immunology*; D006680:HLA Antigens / Q000276:immunology*; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality; D006650:Histocompatibility Testing; D006801:Humans; D015994:Incidence; D007938:Leukemia / Q000276:immunology / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D035781:Siblings; D014019:Tissue Donors; D055815:Young Adult
D006680:HLA Antigens