Allogeneic stem cell transplantation for patients with refractory anaemia with matched related and unrelated donors: delay of the transplant is associated with inferior survival.
Allogeneic stem cell transplantation (alloSCT) for patients with refractory anaemia may result in a 50% event-free survival, but the high non-relapse mortality (NRM) precludes a general application of this therapeutic modality. This study evaluated the impact of various pre-transplant variables, including disease duration, intensity of the conditioning regimen, type of donor and year of transplantation on outcome. The study population consisted of 374 patients; 244 were transplanted from human leucocyte antigen (HLA)-identical siblings and 130 patients from matched unrelated donors. The median age was 39 years. One hundred and two patients were transplanted after reduced intensity conditioning (RIC). The overall 4-year survival was 52%. The 4-year survival of patients transplanted with HLA-identical sibling donors and matched unrelated donors was 52% and 50%, respectively. Multivariate analysis showed an improved survival (P = 0.05) and a lower NRM (P = 0.02) when the transplantation was performed in recent years. Increasing age, and disease duration of >12 months were associated with inferior survival. RIC resulted in a similar survival despite an increased relapse risk (P = 0.02). This improved outcome permits alloSCT in patients older than 50 years of age, even with the use of matched unrelated donors. AlloSCT should be preferentially performed early after diagnosis after careful analysis of prognostic variables.
de Witte
Theo
T
Department of Haematology, Radboud University Medical Centre Nijmegen, Nijmegen, the Netherlands. T.deWitte@hemat.umcn.nl
Brand
Ronald
R
van Biezen
Anja
A
Mufti
Ghulam
G
Ruutu
Tapani
T
Finke
Jürgen
J
von dem Borne
Peter
P
Vitek
Antonin
A
Delforge
Michel
M
Alessandrino
Paolo
P
Harlahakis
Nicolas
N
Russell
Nigel
N
Martino
Roberto
R
Verdonck
Leo
L
Kröger
Nicholas
N
Niederwieser
Dietger
D
D000328:Adult; D000753:Anemia, Refractory / Q000401:mortality / Q000628:therapy*; D018572:Disease-Free Survival; D005260:Female; D006650:Histocompatibility Testing; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D035781:Siblings; D033581:Stem Cell Transplantation / Q000379:methods* / Q000401:mortality; D013997:Time Factors; D014019:Tissue Donors / Q000706:statistics & numerical data; D019172:Transplantation Conditioning / Q000379:methods; D055815:Young Adult