title: Similar overall survival using sibling, unrelated donor, and cord blood grafts after reduced-intensity conditioning for older patients with acute myelogenous leukemia.
abstract: For older patients with acute myeloid leukemia (AML), allogeneic hematopoietic cell transplantation (HCT) provides the best chance of long-term survival. A formal comparison between matched sibling (SIB), unrelated donor (URD), or umbilical cord blood (UCB) transplantation has not yet been reported in this setting. We compared reduced-intensity conditioning HCT in 197 consecutive patients 50 years and older with AML in complete remission from SIB (n = 82), URD (n = 35), or UCB (n = 80) transplantation. The 3-year cumulative incidences of transplantation-related mortality were 18%, 14%, and 24% with SIB, URD, and UCB transplantation, respectively (P = .22). The 3-year leukemia-free survival rates were 48%, 57%, and 33% with SIB, URD, and UCB transplantation, respectively (P = .009). In multivariate analysis, poor-risk cytogenetics was associated with relapse (hazard ratio, 1.7 [95% confidence interval, 1.0 to 3.0]; P = .04) and worse leukemia-free survival (hazard ratio, 1.6 [95% confidence interval, 1.0 to 2.5]; P = .03), whereas donor choice had no significant impact on overall survival (P = .73). Adjusted 3-year overall survival rates were 55% with SIB, 45% with URD, and 43% with UCB transplantation (P = .26). Until prospective studies are completed, this study supports the recommendation to consider SIB donor, URD, or UCB for HCT for older patients with AML in complete remission.
authors.affiliation: Service d'Hématologie Greffe, Hôpital Saint-Louis, AP HP, Paris, France; Equipe d'accueil 3518, Hôpital Saint-Louis & Université Paris 7, AP-HP, Paris, France. regis.peffaultdelatour@sls.aphp.fr
authors.forename: Régis
authors.initials: R
authors.lastname: Peffault de Latour
authors.forename: Claudio G
authors.initials: CG
authors.lastname: Brunstein
authors.forename: Raphael
authors.initials: R
authors.lastname: Porcher
authors.forename: Patrice
authors.initials: P
authors.lastname: Chevallier
authors.forename: Marie
authors.initials: M
authors.lastname: Robin
authors.forename: Erica
authors.initials: E
authors.lastname: Warlick
authors.forename: Alienor
authors.initials: A
authors.lastname: Xhaard
authors.forename: Celalettin
authors.initials: C
authors.lastname: Ustun
authors.forename: Jérôme
authors.initials: J
authors.lastname: Larghero
authors.forename: Nathalie
authors.initials: N
authors.lastname: Dhedin
authors.forename: Mohamad
authors.initials: M
authors.lastname: Mohty
authors.forename: Gerard
authors.initials: G
authors.lastname: Socié
authors.forename: Daniel
authors.initials: D
authors.lastname: Weisdorf
mesh_terms: D000368:Aged; D015331:Cohort Studies; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D035781:Siblings; D016019:Survival Analysis; D014019:Tissue Donors; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods*; D061349:Unrelated Donors
keywords: Acute myeloid leukemia; Cord blood; Older patients; Reduced-intensity conditioning regimen; Unrelated donor