title: Unrelated donor versus matched sibling donor in adults with acute myeloid leukemia in first relapse: an ALWP-EBMT study.
abstract: Allogeneic stem cell transplantation is the only curative option for patients with acute myeloid leukemia (AML) experiencing relapse. Either matched sibling donor (MSD) or unrelated donor (UD) is indicated.
  
  
  
  We analyzed 1554 adults with AML transplanted from MSD (n = 961) or UD (n = 593, HLA-matched 10/10, n = 481; 9/10, n = 112). Compared to MSD, UD recipients were older (49 vs 52 years, p = 0.001), transplanted more recently (2009 vs 2006, p = 0.001), and with a longer interval to transplant (10 vs 9 months, p = 0.001). Conditioning regimen was more frequently myeloablative for patients transplanted with a MSD (61 vs 46 %, p = 0.001). Median follow-up was 28 (range 3-157) months.
  
  
  
  Cumulative incidence (CI) of neutrophil engraftment (p = 0.07), grades II-IV acute GVHD (p = 0.11), chronic GVHD (p = 0.9), and non-relapse mortality (NRM, p = 0.24) was not different according to the type of donor. At 2 years, CI of relapse (relapse incidence (RI)) was 57 vs 49 % (p = 0.001). Leukemia-free survival (LFS) at 2 years was 21 vs 26 % (p = 0.001), and overall survival (OS) was 26 vs 33 % (p = 0.004) for MSD vs UD, respectively. Chronic GVHD as time-dependent variable was associated with lower RI (HR 0.78, p = 0.05), higher NRM (HR 1.71, p = 0.001), and higher OS (HR 0.69, p = 0.001). According to HLA match, RI was 57 vs 50 vs 45 %, (p = 0.001) NRM was 23 vs 23 vs 29 % (p = 0.26), and LFS at 2 years was 21 vs 27 vs 25 % (p = 0.003) for MSD, 10/10, and 9/10 UD, respectively. In multivariate analysis adjusted for differences between the two groups, UD was associated with lower RI (HR 0.76, p = 0.001) and higher LFS (HR 0.83, p = 0.001) compared to MSD. Interval between diagnosis and transplant was the other factor associated with better outcomes (RI (HR 0.62, p < 0.001) and LFS (HR 0.67, p < 0.001)).
  
  
  
  Transplantation using UD was associated with better LFS and lower RI compared to MSD for high-risk patients with AML transplanted in first relapse.
authors.affiliation: Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, 184 Rue du Faubourg Saint Antoine, 75012, Paris, France. annalisaruggeri80@hotmail.com.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Ruggeri
authors.affiliation: Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, 184 Rue du Faubourg Saint Antoine, 75012, Paris, France.|Department of Hematology and Marrow Transplantation, University Federico II of Naples, Naples, Italy.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Battipaglia
authors.affiliation: Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, 184 Rue du Faubourg Saint Antoine, 75012, Paris, France.
authors.forename: Myriam
authors.initials: M
authors.lastname: Labopin
authors.affiliation: Medical Clinic and Polyclinic, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Ehninger
authors.affiliation: Department of Bone Marrow Transplantation, University Hospital Essen, Essen, Germany.
authors.forename: Dietrich
authors.initials: D
authors.lastname: Beelen
authors.affiliation: Department of Internal Medicine III, UH of Munich (LMU), Munich, Germany.
authors.forename: Johanna
authors.initials: J
authors.lastname: Tischer
authors.affiliation: Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany.
authors.forename: Arnold
authors.initials: A
authors.lastname: Ganser
authors.affiliation: Department of Haematology, Oncology Helios-Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Schwerdtfeger
authors.affiliation: Department of Hematology, Oncology and Stem Cell Transplantation, Asklepios Hospital St. Georg, Hamburg, Germany.
authors.forename: Bertram
authors.initials: B
authors.lastname: Glass
authors.affiliation: Department of Hematology/Oncology and Stem Cell Transplantation, University Medical Center, Freiburg, Germany.
authors.forename: Jurgen
authors.initials: J
authors.lastname: Finke
authors.affiliation: Department of Hematology, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre Bénite, France.
authors.forename: Mauricette
authors.initials: M
authors.lastname: Michallet
authors.affiliation: Department of Medicine A, University of Muenster, Munster, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Stelljes
authors.affiliation: Departments of Hematology/Oncology, Charles University Hospital, Pilsen, Czech Republic.
authors.forename: Pavel
authors.initials: P
authors.lastname: Jindra
authors.affiliation: Charité Universitatsmedizin, 10117, Berlin, Germany.
authors.forename: Renate
authors.initials: R
authors.lastname: Arnold
authors.affiliation: University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Nicolaus
authors.initials: N
authors.lastname: Kröger
authors.affiliation: Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, 184 Rue du Faubourg Saint Antoine, 75012, Paris, France.|Hôpital Saint-Antoine, Paris University UPMC, INSERM U938, Paris, France.|Université Pierre and Marie Curie, Paris, France.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Mohty
authors.affiliation: Université Pierre and Marie Curie, Paris, France.|Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel.|ALWP Office, Hôpital Saint Antoine, AP-HP, Paris, France.
authors.forename: Arnon
authors.initials: A
authors.lastname: Nagler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001782:Blood Donors; D018572:Disease-Free Survival; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012042:Registries; D012189:Retrospective Studies; D035781:Siblings; D015996:Survival Rate; D061349:Unrelated Donors; D055815:Young Adult
keywords: Acute myeloid leukemia; Matched sibling donor; Relapse; Unrelated donor