title: The graft-versus-leukemia effect using matched unrelated donors is not superior to HLA-identical siblings for hematopoietic stem cell transplantation.
abstract: 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.
authors.affiliation: Center for Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Stockholm, Sweden. Olle.Ringden@ki.se
authors.forename: Olle
authors.initials: O
authors.lastname: Ringdén
authors.forename: Steven Z
authors.initials: SZ
authors.lastname: Pavletic
authors.forename: Claudio
authors.initials: C
authors.lastname: Anasetti
authors.forename: A John
authors.initials: AJ
authors.lastname: Barrett
authors.forename: Tao
authors.initials: T
authors.lastname: Wang
authors.forename: Dan
authors.initials: D
authors.lastname: Wang
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Antin
authors.forename: Paolo
authors.initials: P
authors.lastname: Di Bartolomeo
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Bolwell
authors.forename: Christopher
authors.initials: C
authors.lastname: Bredeson
authors.forename: Mitchell S
authors.initials: MS
authors.lastname: Cairo
authors.forename: Robert P
authors.initials: RP
authors.lastname: Gale
authors.forename: Vikas
authors.initials: V
authors.lastname: Gupta
authors.forename: Theresa
authors.initials: T
authors.lastname: Hahn
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Hale
authors.forename: Jorg
authors.initials: J
authors.lastname: Halter
authors.forename: Madan
authors.initials: M
authors.lastname: Jagasia
authors.forename: Mark R
authors.initials: MR
authors.lastname: Litzow
authors.forename: Franco
authors.initials: F
authors.lastname: Locatelli
authors.forename: David I
authors.initials: DI
authors.lastname: Marks
authors.forename: Philip L
authors.initials: PL
authors.lastname: McCarthy
authors.forename: Morton J
authors.initials: MJ
authors.lastname: Cowan
authors.forename: Effie W
authors.initials: EW
authors.lastname: Petersdorf
authors.forename: James A
authors.initials: JA
authors.lastname: Russell
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Schiller
authors.forename: Harry
authors.initials: H
authors.lastname: Schouten
authors.forename: Stephen
authors.initials: S
authors.lastname: Spellman
authors.forename: Leo F
authors.initials: LF
authors.lastname: Verdonck
authors.forename: John R
authors.initials: JR
authors.lastname: Wingard
authors.forename: Mary M
authors.initials: MM
authors.lastname: Horowitz
authors.forename: Mukta
authors.initials: M
authors.lastname: Arora
mesh_terms: 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
chemical_list: D006680:HLA Antigens