title: HLA-identical sibling compared with 8/8 matched and mismatched unrelated donor bone marrow transplant for chronic phase chronic myeloid leukemia.
abstract: OBJECTIVE
  Transplantation of hematopoietic stem cells from an unrelated donor (URD) is an option for many patients who do not have an HLA-identical sibling donor (MSD). Current criteria for the selection of URDs include consideration for HLA alleles determined by high resolution typing methods, with preference for allele-matched donors. However, the utility and outcome associated with transplants from URDs compared with those from MSDs remains undefined.
  
  
  METHODS
  We examined clinical outcome after patients received bone marrow transplants (BMTs) from MSDs; HLA-A, -B, -C, and DRB1 allele-matched URDs (8/8); and HLA-mismatched URDs in a homogeneous population of patients with chronic myeloid leukemia (CML) in first chronic phase (CP1) where a strong allogeneic effect and hence a lower risk of relapse is anticipated. Transplantation outcomes were compared between 1,052 URD and 3,514 MSD BMT recipients with CML in CP1.
  
  
  RESULTS
  Five-year overall survival and leukemia-free survival (LFS) after receipt of BMTs from 8/8 matched URDs were worse than those after receipt of BMTs from MSDs (5-year survival, 55% v 63%; RR, 1.35; 95% CI, 1.17 to 1.56; P < .001; LFS, 50% v 55%; RR, 1.21; 95% CI, 1.06 to 1.40; P = .006). Survival was progressively worse with greater degrees of mismatch. Similar and low risk of relapse were observed after receipt of transplant from either MSD or URD.
  
  
  CONCLUSIONS
  In this homogeneous cohort of good risk patients with CML in CP1, 5-year overall survival and LFS after receipt of transplant from 8/8 allele-matched donors were modestly though significantly worse than those after receipt of transplant from MSDs. Additive adverse effects of multilocus mismatching are not well tolerated and should be avoided if possible.
authors.affiliation: University of Minnesota, National Marrow Donor Program, Center for International Blood and Marrow Transplant Research, Minneapolis, MN 55455, USA. arora005@umn.edu
authors.forename: Mukta
authors.initials: M
authors.lastname: Arora
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Weisdorf
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Spellman
authors.forename: Michael D
authors.initials: MD
authors.lastname: Haagenson
authors.forename: John P
authors.initials: JP
authors.lastname: Klein
authors.forename: Carolyn K
authors.initials: CK
authors.lastname: Hurley
authors.forename: George B
authors.initials: GB
authors.lastname: Selby
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Antin
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Kernan
authors.forename: Craig
authors.initials: C
authors.lastname: Kollman
authors.forename: Auayporn
authors.initials: A
authors.lastname: Nademanee
authors.forename: Philip
authors.initials: P
authors.lastname: McGlave
authors.forename: Mary M
authors.initials: MM
authors.lastname: Horowitz
authors.forename: Effie W
authors.initials: EW
authors.lastname: Petersdorf
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016026:Bone Marrow Transplantation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology; D015395:Histocompatibility Antigens Class I / Q000276:immunology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000276:immunology / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D035781:Siblings; D014019:Tissue Donors; D016896:Treatment Outcome
chemical_list: D015395:Histocompatibility Antigens Class I