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The graft-versus-leukemia effect using matched unrelated donors is not superior to HLA-identical siblings for hematopoietic stem cell transplantation

2008; Elsevier BV; Volume: 113; Issue: 13 Linguagem: Inglês

10.1182/blood-2008-07-163212

1528-0020

Olle Ringdén, Steven Z. Pavletic, Claudio Anasetti, A. John Barrett, Tao Wang, Dan Wang, Joseph H. Antin, Paolo Di Bartolomeo, Brian J. Bolwell, Christopher Bredeson, Mitchell S. Cairo, Robert Peter Gale, Vikas Gupta, Theresa Hahn, Gregory A. Hale, Jörg Halter, Madan Jagasia, Mark R. Litzow, Franco Locatelli, David I. Marks, Philip L. McCarthy, Morton J. Cowan, Effie W. Petersdorf, James A. Russell, Gary J. Schiller, Harry C. Schouten, Stephen R. Spellman, Leo F. Verdonck, John R. Wingard, Mary M. Horowitz, Mukta Arora,

Immune Cell Function and Interaction

Abstract Do some patients benefit from an unrelated donor (URD) transplant because of a stronger graft-versus-leukemia (GVL) effect? We analyzed 4099 patients with acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), and chronic myeloid leukemia (CML) undergoing a myeloablative allogeneic hematopoietic cell transplantation (HCT) from an URD (8/8 human leukocyte antigen [HLA]–matched, n = 941) or HLA-identical sibling donor (n = 3158) between 1995 and 2004 reported to the CIBMTR. In the Cox regression model, acute and chronic GVHD were added as time-dependent variables. In multivariate analysis, URD transplant recipients had a higher risk for transplantation-related mortality (TRM; relative risk [RR], 2.76; P < .001) and relapse (RR, 1.50; P < .002) in patients with AML, but not ALL or CML. Chronic GVHD was associated with a lower relapse risk in all diagnoses. Leukemia-free survival (LFS) was decreased in patients with AML without acute GVHD receiving a URD transplant (RR, 2.02; P < .001) but was comparable to those receiving HLA-identical sibling transplants in patients with ALL and CML. In patients without GVHD, multivariate analysis showed similar risk of relapse but decreased LFS for URD transplants for all 3 diagnoses. In conclusion, risk of relapse was the same (ALL, CML) or worse (AML) in URD transplant recipients compared with HLA-identical sibling transplant recipients, suggesting a similar GVL effect.