Concurrent search for unrelated cord and volunteer donor in high-risk acute lymphoblastic leukemia.
To assess the effectiveness of the search for an unrelated donor on the outcome of patients with high-risk acute lymphoblastic leukemia, we analyzed prospectively 136 patients who underwent a search for cord blood (CB) and an unrelated volunteer donor (UD) at the same time. The probability of finding a donor was 58.2%, 70.3%, and 75.7% at 3, 6, and 12 months, respectively. The median time to find a donor was 1.8 months for CB and 3.5 months for UD. Of the 99 patients with a donor, 38.4% failed to undergo the transplant because of a relapse observed at a median of 4 months from the start of the search. In univariate analysis, absence of relapse during the search (p < 0.0001) and transplant (p = 0.004) showed a positive impact on long-term survival. In multivariate analysis, relapse during the search remained the key factor affecting survival (p < 0.0001). Since an extension of the search beyond 3 months enables only a slight increase in the probability of finding a donor compared to the increased risk of relapse, the time of the search should not exceed the 3-month time point. The simultaneous search for CB and UD increases the likelihood of performing a timely transplant.
Department of Hematology, Azienda Policlinico Umberto I, Sapienza University, Rome, Italy. iori@bce.uniroma1.it
Anna Paola
AP
Iori
Veronica
V
Valle
Alfonso
A
Piciocchi
Giovanna
G
Meloni
Giovanni Fernando
GF
Torelli
Antonella
A
Vitale
Anna Maria
AM
Testi
Walter
W
Barberi
Roberto
R
Ricci
Filippo
F
Milano
Barbarella
B
Lucarelli
Maria
M
Screnci
Maria Paola
MP
Perrone
Luca
L
Laurenti
Fiammetta
F
Natalino
Salvatore
S
Perrone
Nicoletta
N
Sacchi
William
W
Arcese
Roberto
R
Foà
D000293:Adolescent; D000328:Adult; D001782:Blood Donors; D002648:Child; D002675:Child, Preschool; D005260:Female; D005312:Fetal Blood / Q000166:cytology; D006650:Histocompatibility Testing / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000453:epidemiology / Q000276:immunology* / Q000401:mortality / Q000628:therapy*; D012008:Recurrence; D012074:Remission Induction; D012307:Risk Factors; D016019:Survival Analysis; D061349:Unrelated Donors; D014838:Volunteers; D055815:Young Adult