title: Impact of Donor Type on Outcome after Allogeneic Hematopoietic Cell Transplantation for Acute Leukemia.
abstract: Allogeneic hematopoietic cell transplantation (alloHCT) is considered the most potent postremission antileukemic therapy in adults with acute leukemia. We analyzed 172 consecutive acute leukemia patients transplanted in complete remission after a T cell-replete alloHCT from either a matched related (MRD, n = 54), unrelated (MUD, n = 67), or haploidentical (haplo, n = 51) donor to look for patient-, disease-, and transplant-related factors associated with post-transplant outcomes. Patients included 123 acute myeloid leukemia patients (first complete remission [CR], n = 94; second CR, n = 28; third CR, n = 1) and 49 acute lymphoblastic leukemia (ALL) patients (first CR, n = 39; second CR, n = 9; third CR, n = 1) with a median age of 50 years (range, 19 to 74). Median follow-up for surviving patients was 38 months. Cumulative incidence of nonrelapse mortality at 1 and 3 years was 6% and 17%, respectively. The estimated rates of 3-year overall survival, disease-free survival, and relapse incidence were 59%, 50%, and 33%, respectively. In multivariate analysis, risk factors for inferior survival included diagnosis of ALL, high risk disease risk index, and use of a female donor for a male recipient. Donor type (MRD, MUD, haplo) had no impact on any transplant outcome. Given the favorable outcomes associated with alloHCT in acute leukemia and lack of effect of donor type, a strong case can be made for transplanting acute leukemia patients in remission as soon as any donor becomes available.
authors.affiliation: The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, Georgia. Electronic address: ssolomon@bmtga.com.
authors.forename: Scott R
authors.initials: SR
authors.lastname: Solomon
authors.affiliation: The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, Georgia.
authors.forename: Connie A
authors.initials: CA
authors.lastname: Sizemore
authors.affiliation: Mathematics and Statistics, Georgia State University, Atlanta, Georgia.
authors.forename: Xu
authors.initials: X
authors.lastname: Zhang
authors.affiliation: The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, Georgia.
authors.forename: Stacey
authors.initials: S
authors.lastname: Brown
authors.affiliation: The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, Georgia.
authors.forename: H Kent
authors.initials: HK
authors.lastname: Holland
authors.affiliation: The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, Georgia.
authors.forename: Lawrence E
authors.initials: LE
authors.lastname: Morris
authors.affiliation: The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, Georgia.
authors.forename: Melhem
authors.initials: M
authors.lastname: Solh
authors.affiliation: The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, Georgia.
authors.forename: Asad
authors.initials: A
authors.lastname: Bashey
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods* / Q000401:mortality; D006648:Histocompatibility / Q000276:immunology*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality / Q000628:therapy*; D012008:Recurrence; D012074:Remission Induction; D012307:Risk Factors; D016019:Survival Analysis; D014019:Tissue Donors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
keywords: Acute lymphoblastic leukemia; Acute myeloid leukemia; Disease risk index; Haploidentical transplantation; Unrelated donor transplantation