HLA-identical sibling compared with 8/8 matched and mismatched unrelated donor bone marrow transplant for chronic phase chronic myeloid leukemia.
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.
Arora
Mukta
M
University of Minnesota, National Marrow Donor Program, Center for International Blood and Marrow Transplant Research, Minneapolis, MN 55455, USA. arora005@umn.edu
Weisdorf
Daniel J
DJ
Spellman
Stephen R
SR
Haagenson
Michael D
MD
Klein
John P
JP
Hurley
Carolyn K
CK
Selby
George B
GB
Antin
Joseph H
JH
Kernan
Nancy A
NA
Kollman
Craig
C
Nademanee
Auayporn
A
McGlave
Philip
P
Horowitz
Mary M
MM
Petersdorf
Effie W
EW
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
D015395:Histocompatibility Antigens Class I