title: Who is the best hematopoietic stem-cell donor for a male patient with acute leukemia?
abstract: BACKGROUND
  Female donors for male recipients worsen the outcome of allogeneic hematopoietic stem-cell transplantation. We wanted to find out whether a male human leukocyte antigen (HLA)-matched unrelated donor (MUD, 8/8, n=2,014) might be an alternative to a female HLA-identical sibling donor (n=2,656) for male patients with acute leukemia.
  
  
  METHODS
  This is a retrospective analysis from the Acute Leukaemia Working Party of the European Group for Blood and Marrow Transplantation.
  
  
  RESULTS
  The relative risk (RR) of acute graft-versus-host disease (GVHD) of grades II to IV was increased in the MUD group with acute myeloid leukemia (AML) (RR, 1.47; P<0.001) and acute lymphoblastic leukemia (ALL) (RR, 1.76; P<0.001). There was no difference in incidence of chronic GVHD and nonrelapse mortality between the two groups. Probability of relapse was lower in the MUD group than in the sibling group in patients with ALL (hazards ratio [HR], 0.75; P=0.04) but not in the AML patients (HR, 0.89; P=0.17). Survival was not different between the groups. Leukemia-free survival (LFS) was also similar in the sibling and MUD groups in patients with AML (HR, 1.01; P=0.81) or ALL (HR, 0.93; P=0.45). Factors significantly associated with reduced LFS included active disease, poor cytogenetics, age, year of hematopoietic stem-cell transplantation, reduced-intensity conditioning, and the use of antithymocyte globulin.
  
  
  CONCLUSIONS
  Male patients who received grafts from male MUDs demonstrated an increased incidence of acute GVHD and LFS same as when using HLA-identical female donors.
authors.affiliation: 1 Center for Allogeneic Stem Cell Transplantation and Division of Therapeutic Immunology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden. 2 Department of Haematology, Hôpital Saint Antoine, Paris, France. 3 Department of Bone Marrow Transplantation, Essen, University Hospital, Essen, Germany. 4 Medizinische Klinik m. S. Hämatologie/Onkologie, Charité Universitätsmedizin, Berlin, Germany. 5 Medizinische Klinik und Poliklinik I, Universitätsklinikum Dresden, Dresden, Germany. 6 CHU Bordeaux, Hôpital Haut-leveque, Pessac, France. 7 Division of Hematology, Oncology and Hemostasiology, University Hospital Leipzig, Leipzig, Germany. 8 Service Hématologie Greffe de Moelle, Centre Pierre et Marie Curie, Alger, Algeria. 9 Department of Hematology and BMT, Silesian Medical Academy, Katowice, Poland. 10 Department of Hematology/Oncology, Hannover Medical University, Hannover, Germany. 11 Department of Hematology - BMT, Hôpital St. Louis, Paris, France. 12 Department of Hematology/Oncology, University of Münster, Münster, Germany. 13 Division of Hematology, Helsinki University Central Hospital, Helsinki, Finland. 14 Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom. 15 Address correspondence to: Olle Ringdén, M.D., Ph.D., Karolinska Institutet, Division of Therapeutic Immunology, Karolinska University Hospital Huddinge, F79, SE-141 86 Stockholm, Sweden.
authors.forename: Olle
authors.initials: O
authors.lastname: Ringdén
authors.forename: Myriam
authors.initials: M
authors.lastname: Labopin
authors.forename: Martin
authors.initials: M
authors.lastname: Solders
authors.forename: Dietrich
authors.initials: D
authors.lastname: Beelen
authors.forename: Renate
authors.initials: R
authors.lastname: Arnold
authors.forename: Gerhard
authors.initials: G
authors.lastname: Ehninger
authors.forename: Noel
authors.initials: N
authors.lastname: Milpied
authors.forename: Dietger
authors.initials: D
authors.lastname: Niederwieser
authors.forename: Rose-Marie
authors.initials: RM
authors.lastname: Hamladji
authors.forename: Slawomira
authors.initials: S
authors.lastname: Kyrcz-Krzemien
authors.forename: Arnold
authors.initials: A
authors.lastname: Ganser
authors.forename: Gerard
authors.initials: G
authors.lastname: Socié
authors.forename: Matthias
authors.initials: M
authors.lastname: Stelljes
authors.forename: Liisa
authors.initials: L
authors.lastname: Volin
authors.forename: Charles
authors.initials: C
authors.lastname: Craddock
authors.forename: Mohamad
authors.initials: M
authors.lastname: Mohty
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D015994:Incidence; D015470:Leukemia, Myeloid, Acute / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D016019:Survival Analysis; D014184:Transplantation, Homologous / Q000379:methods; D016896:Treatment Outcome; D061349:Unrelated Donors; D055815:Young Adult