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Alternative donor transplantation for older patients with acute myeloid leukemia in first complete remission: a center for international blood and marrow transplant research-eurocord analysis.
Biol Blood Marrow Transplant. 2014 Jun; 20(6):816-22.BB

Abstract

We studied patients with acute myeloid leukemia (AML) over age 50 and in first complete remission (CR1) after adult unrelated donor (URD) (n = 441, 8/8 HLA matched; n = 94, 7/8 HLA matched) or umbilical cord blood (UCB; n = 205) transplantations. UCB recipients achieved CR1 within 8 weeks less often, and received reduced-intensity conditioning and cyclosporine-based graft-versus-host disease (GVHD) prophylaxis more often. Neutrophil recovery was slower in UCB (69% by day 28) compared with 8/8 HLA-matched URD (97%) and 7/8 HLA-matched (91%) (P < .001) recipients. Three-year transplantation-related mortality (TRM) was higher and leukemia-free survival (LFS) lower with UCB (35% and 28%, respectively) versus 8/8 HLA-matched URD (27% and 39%, respectively). TRM was higher in 7/8 HLA-matched URD (41%, P = .01), but LFS was similar at 34% (P = .39). Three-year chronic GVHD was the lowest in UCB (28%) versus 53% and 59% in 8/8 and 7/8 HLA-matched URD recipients, respectively. Three-year survival was 43% in 8/8 HLA-matched URD (95% confidence interval [CI], 38% to 48%), 30% in UCB (95% CI, 23% to 37%) (P = .002) and 37% in 7/8 URD (95% CI, 27 to 46). Allotransplantation for AML in CR1 with any of these grafts extends LFS for over one third of older patients. In the absence of an 8/8 HLA-matched URD or when transplantation is needed urgently, UCB can provide extended survival. Less frequent chronic GVHD with UCB transplantation may be of particular value for older patients.

Authors+Show Affiliations

Department of Medicine, Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota; Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin. Electronic address: weisd001@umn.edu.Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.Eurocord, Hopital Saint Louis, Paris, France; Service d Hematologie et Therapie Cellulaire, Hopital Saint Antoine, Paris, France.Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Eurocord, Hopital Saint Louis, Paris, France; Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin.Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin.Department of Medicine, Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota.Department of Medicine, Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota.Eurocord, Hopital Saint Louis, Paris, France; Oxford University Hospitals NHS Trust, Department of Clinical Haematology, Churchill Hospital, Oxford, United Kingdom.Eurocord, Hopital Saint Louis, Paris, France; Université Paris Diderot, Paris, France.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24582782

Citation

Weisdorf, Daniel, et al. "Alternative Donor Transplantation for Older Patients With Acute Myeloid Leukemia in First Complete Remission: a Center for International Blood and Marrow Transplant Research-eurocord Analysis." Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation, vol. 20, no. 6, 2014, pp. 816-22.
Weisdorf D, Eapen M, Ruggeri A, et al. Alternative donor transplantation for older patients with acute myeloid leukemia in first complete remission: a center for international blood and marrow transplant research-eurocord analysis. Biol Blood Marrow Transplant. 2014;20(6):816-22.
Weisdorf, D., Eapen, M., Ruggeri, A., Zhang, M. J., Zhong, X., Brunstein, C., Ustun, C., Rocha, V., & Gluckman, E. (2014). Alternative donor transplantation for older patients with acute myeloid leukemia in first complete remission: a center for international blood and marrow transplant research-eurocord analysis. Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation, 20(6), 816-22. https://doi.org/10.1016/j.bbmt.2014.02.020
Weisdorf D, et al. Alternative Donor Transplantation for Older Patients With Acute Myeloid Leukemia in First Complete Remission: a Center for International Blood and Marrow Transplant Research-eurocord Analysis. Biol Blood Marrow Transplant. 2014;20(6):816-22. PubMed PMID: 24582782.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Alternative donor transplantation for older patients with acute myeloid leukemia in first complete remission: a center for international blood and marrow transplant research-eurocord analysis. AU - Weisdorf,Daniel, AU - Eapen,Mary, AU - Ruggeri,Annalisa, AU - Zhang,Mei-Jie, AU - Zhong,Xiaobo, AU - Brunstein,Claudio, AU - Ustun,Celalettin, AU - Rocha,Vanderson, AU - Gluckman,Eliane, Y1 - 2014/02/26/ PY - 2014/01/23/received PY - 2014/02/22/accepted PY - 2014/3/4/entrez PY - 2014/3/4/pubmed PY - 2015/4/10/medline KW - Acute myeloid leukemia KW - Allogeneic transplantation KW - Umbilical cord blood KW - Unrelated donors SP - 816 EP - 22 JF - Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation JO - Biol Blood Marrow Transplant VL - 20 IS - 6 N2 - We studied patients with acute myeloid leukemia (AML) over age 50 and in first complete remission (CR1) after adult unrelated donor (URD) (n = 441, 8/8 HLA matched; n = 94, 7/8 HLA matched) or umbilical cord blood (UCB; n = 205) transplantations. UCB recipients achieved CR1 within 8 weeks less often, and received reduced-intensity conditioning and cyclosporine-based graft-versus-host disease (GVHD) prophylaxis more often. Neutrophil recovery was slower in UCB (69% by day 28) compared with 8/8 HLA-matched URD (97%) and 7/8 HLA-matched (91%) (P < .001) recipients. Three-year transplantation-related mortality (TRM) was higher and leukemia-free survival (LFS) lower with UCB (35% and 28%, respectively) versus 8/8 HLA-matched URD (27% and 39%, respectively). TRM was higher in 7/8 HLA-matched URD (41%, P = .01), but LFS was similar at 34% (P = .39). Three-year chronic GVHD was the lowest in UCB (28%) versus 53% and 59% in 8/8 and 7/8 HLA-matched URD recipients, respectively. Three-year survival was 43% in 8/8 HLA-matched URD (95% confidence interval [CI], 38% to 48%), 30% in UCB (95% CI, 23% to 37%) (P = .002) and 37% in 7/8 URD (95% CI, 27 to 46). Allotransplantation for AML in CR1 with any of these grafts extends LFS for over one third of older patients. In the absence of an 8/8 HLA-matched URD or when transplantation is needed urgently, UCB can provide extended survival. Less frequent chronic GVHD with UCB transplantation may be of particular value for older patients. SN - 1523-6536 UR - https://www.unboundmedicine.com/medline/citation/24582782/Alternative_donor_transplantation_for_older_patients_with_acute_myeloid_leukemia_in_first_complete_remission:_a_center_for_international_blood_and_marrow_transplant_research_eurocord_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1083-8791(14)00135-9 DB - PRIME DP - Unbound Medicine ER -