title: Matched and mismatched unrelated donor compared to autologous stem cell transplantation for acute myeloid leukemia in first complete remission: a retrospective, propensity score-weighted analysis from the ALWP of the EBMT.
abstract: Optimal post-remission strategy for patients with acute myeloid leukemia (AML) is matter of intense debate. Recent reports have shown stronger anti-leukemic activity but similar survival for allogeneic stem cell transplantation (allo-HSCT) from matched sibling donor compared to autologous transplantation (auto-HSCT); however, there is scarcity of literature confronting auto-HSCT with allo-HSCT from unrelated donor (UD-HSCT), especially mismatched UD-HSCT.
  
  
  
  We retrospectively compared outcome of allogeneic transplantation from matched (10/10 UD-HSCT) or mismatched at a single HLA-locus unrelated donor (9/10 UD-HSCT) to autologous transplantation in patients with AML in first complete remission (CR1). A total of 2879 patients were included; 1202 patients received auto-HSCT, 1302 10/10 UD-HSCT, and 375 9/10 UD-HSCT. A propensity score-weighted analysis was conducted to control for disease risk imbalances between the groups.
  
  
  
  Matched 10/10 UD-HSCT was associated with the best leukemia-free survival (10/10 UD-HSCT vs auto-HSCT: HR 0.7, p = 0.0016). Leukemia-free survival was not statistically different between auto-HSCT and 9/10 UD-HSCT (9/10 UD-HSCT vs auto-HSCT: HR 0.8, p = 0.2). Overall survival was similar across the groups (10/10 UD-HSCT vs auto-HSCT: HR 0.98, p = 0.84; 9/10 UD-HSCT vs auto-HSCT: HR 1.1, p = 0.49). Notably, in intermediate-risk patients, OS was significantly worse for 9/10 UD-HSCT (9/10 UD-HSCT vs auto-HSCT: HR 1.6, p = 0.049), while it did not differ between auto-HSCT and 10/10 UD-HSCT (HR 0.95, p = 0.88). In favorable risk patients, auto-HSCT resulted in 3-year LFS and OS rates of 59 and 78 %, respectively.
  
  
  
  Our findings suggest that in AML patients in CR1 lacking an HLA-matched sibling donor, 10/10 UD-HSCT significantly improves LFS, but this advantage does not translate in better OS compared to auto-HSCT. In intermediate-risk patients lacking a fully HLA-matched donor, auto-HSCT should be considered as a valid option, as better survival appears to be provided by auto-HSCT compared to mismatched UD-HSCT. Finally, auto-HSCT provided an encouraging outcome in patients with favorable risk AML.
authors: Hematology and Bone Marrow Transplantation, Polytechnic University of Marche-Ospedali Riuniti Ancona, Via Conca 71, 60126, Ancona, Italy. francesco.saraceni@libero.it.
authors: Francesco
authors: F
authors: Saraceni
authors: ALWP-EBMT and Department of Hematology and Cell Therapy, Saint Antoine Hospital, Paris, France.
authors: Myriam
authors: M
authors: Labopin
authors: ALWP-EBMT and Department of Hematology and Cell Therapy, Saint Antoine Hospital, Paris, France.
authors: Norbert-Claude
authors: NC
authors: Gorin
authors: Programme de Transplantation et Therapie Cellulaire-Institut Paoli Calmettes, Marseille, France.
authors: Didier
authors: D
authors: Blaise
authors: CHU Bordeaux, Hôpital Haut-Leveque, Pessac, France.
authors: Reza
authors: R
authors: Tabrizi
authors: HUH, Comprehensive Cancer Center, Stem Cell Transplantation Unit, Helsinki, Finland.
authors: Liisa
authors: L
authors: Volin
authors: Erasmus MC-Daniel den Hoed Cancer Centre, Rotterdam, The Netherlands.
authors: Jan
authors: J
authors: Cornelissen
authors: Clinique Universitaire d'Hématologie CHU Grenoble, Grenoble, France.
authors: Jean-Yves
authors: JY
authors: Cahn
authors: Department D'Hématologie, CHU Nantes, Nantes, France.
authors: Patrice
authors: P
authors: Chevallier
authors: Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK.
authors: Charles
authors: C
authors: Craddock
authors: Department of Hematology, First Affiliated Hospital of Soochow University, Suzhou, China.
authors: Depei
authors: D
authors: Wu
authors: CHU Department Hématologie, Hôpital de Purpan, Toulouse, France.
authors: Anne
authors: A
authors: Huynh
authors: Rome Transplant Network, Stem Cell Transplant Unit, Tor Vergata University of Rome, Rome, Italy.
authors: William
authors: W
authors: Arcese
authors: ALWP-EBMT and Department of Hematology and Cell Therapy, Saint Antoine Hospital, Paris, France.
authors: Mohamad
authors: M
authors: Mohty
authors: Chaim Sheba Medical Center, Tel-Hashomer, Israel.|ALWP-EBMT Office, Saint Antoine Hospital, Paris, France.
authors: Arnon
authors: A
authors: Nagler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001782:Blood Donors; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006648:Histocompatibility / Q000276:immunology*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012074:Remission Induction; D012189:Retrospective Studies; D035781:Siblings; D016019:Survival Analysis; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D061349:Unrelated Donors; D055815:Young Adult
keywords: Acute myeloid leukemia (AML); Allogeneic transplantation; Autologous transplantation; Matched (10/10) and mismatched (9/10) unrelated donor transplantation; Post-remission therapy