title: Outcomes of allogeneic hematopoietic cell transplantation for adolescent and young adults compared with children and older adults with acute myeloid leukemia.
abstract: Adolescents and young adults (AYAs) with cancer have not experienced improvements in survival to the same extent as children and older adults. We compared outcomes among children (<15 years), AYAs (15-40 years) and older adults (>40 years) receiving allogeneic hematopoietic cell transplant (HCT) for acute myeloid leukemia (AML). Our cohort consisted of 900 children, 2,708 AYA, and 2,728 older adult recipients of HLA-identical sibling or unrelated donor (URD) transplantation using myeloablative or reduced-intensity/nonmyeloablative conditioning. Outcomes were assessed over three time periods (1980-1988, 1989-1997, 1998-2005) for siblings and two time periods (1989-1997, 1998-2005) for URD HCT. Analyses were stratified by donor type. Results showed overall survival for AYAs using either siblings or URD improved over time. Although children had better and older adults had worse survival compared with AYAs, improvements in survival for AYAs did not lag behind those for children and older adults. After sibling donor HCT, 5-year adjusted survival for the three time periods was 40%, 48%, and 53% for children, 35%, 41%, and 42% for AYAs, and 22%, 30%, and 34% for older adults. Among URD HCT recipients, 5-year adjusted survival for the two time periods was 38% and 37% for children, 24% and 28% for AYAs, and 19% and 23% for older adults. Improvements in survival occurred because of a reduction in risk of treatment-related mortality. The risk of relapse did not change over time. Improvements in survival among AYAs undergoing allogeneic HCT for AML have paralleled those among children and older adults.
authors: National Marrow Donor Program and Center for International Blood and Marrow Transplant Research, Minneapolis, MN 55413, USA. nmajhail@nmdp.org
authors: Navneet S
authors: NS
authors: Majhail
authors: Ruta
authors: R
authors: Brazauskas
authors: Anna
authors: A
authors: Hassebroek
authors: Christopher N
authors: CN
authors: Bredeson
authors: Theresa
authors: T
authors: Hahn
authors: Gregory A
authors: GA
authors: Hale
authors: Mary M
authors: MM
authors: Horowitz
authors: Hillard M
authors: HM
authors: Lazarus
authors: Richard T
authors: RT
authors: Maziarz
authors: William A
authors: WA
authors: Wood
authors: Susan K
authors: SK
authors: Parsons
authors: Steven
authors: S
authors: Joffe
authors: J Douglas
authors: JD
authors: Rizzo
authors: Stephanie J
authors: SJ
authors: Lee
authors: Brandon M
authors: BM
authors: Hayes-Lattin
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000517:prevention & control*; D006680:HLA Antigens / Q000276:immunology; D018380:Hematopoietic Stem Cell Transplantation; D006650:Histocompatibility Testing; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D008297:Male; D012189:Retrospective Studies; D055502:Secondary Prevention; D035781:Siblings; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D061349:Unrelated Donors; D055815:Young Adult
chemical_list: D006680:HLA Antigens