HLA-allele matched unrelated donors compared to HLA-matched sibling donors: role of cell source and disease risk category.
To determine whether the risks of allogeneic transplantation are different when the donor is a fully matched unrelated donor (MUD; based on 10/10 HLA alleles) compared to an HLA-identical sibling, we performed a retrospective analysis of 1448 patients with high-risk or advanced hematologic malignancies given T-replete grafts after myeloablative conditioning. No statistically significant differences were found between recipients of a matched sibling donor (MSD) and 10/10 MUD in survival, disease-free survival (DFS), and nonrelapse mortality (NRM) for patients with high-risk disease or those given bone marrow as a graft source. However, for patients with intermediate-risk disease receiving peripheral blood grafts, we observed higher NRM and lower overall survival (OS) in the 10/10 MUD group compared to the MSD cohort. Graft-versus-host disease (GVHD) was higher in the MUD group compared to the MSD group. These results suggest that if a patient has high-risk disease and an MSD is not available, selection of an HLA-allele-matched MUD may provide similar OS and DFS, and therefore lack of an MSD in and of itself should not preclude such a patient from undergoing transplantation. However, for patients with intermediate-risk disease, transplantation with peripheral blood from a 10/10 MUD is associated with lower survival than an MSD.
Woolfrey
Ann
A
Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, USA. awoolfre@fhcrc.org
Lee
Stephanie J
SJ
Gooley
Ted A
TA
Malkki
Mari
M
Martin
Paul J
PJ
Pagel
John M
JM
Hansen
John A
JA
Petersdorf
Effie
E
D000293:Adolescent; D000328:Adult; D000368:Aged; D016026:Bone Marrow Transplantation / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology / Q000209:etiology; D006680:HLA Antigens / Q000032:analysis*; D019337:Hematologic Neoplasms / Q000401:mortality / Q000601:surgery; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000627:therapeutic use; D009928:Organ Specificity; D036102:Peripheral Blood Stem Cell Transplantation / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012306:Risk; D035781:Siblings; D019172:Transplantation Conditioning; D016896:Treatment Outcome; D055815:Young Adult
D006680:HLA Antigens; D019653:Myeloablative Agonists
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