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Unrelated donor versus matched sibling donor in adults with acute myeloid leukemia in first relapse: an ALWP-EBMT study.
J Hematol Oncol. 2016 09 17; 9(1):89.JH

Abstract

BACKGROUND

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.

METHODS

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.

RESULTS

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)).

CONCLUSIONS

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+Show Affiliations

Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, 184 Rue du Faubourg Saint Antoine, 75012, Paris, France. annalisaruggeri80@hotmail.com.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.Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, 184 Rue du Faubourg Saint Antoine, 75012, Paris, France.Medical Clinic and Polyclinic, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany.Department of Bone Marrow Transplantation, University Hospital Essen, Essen, Germany.Department of Internal Medicine III, UH of Munich (LMU), Munich, Germany.Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany.Department of Haematology, Oncology Helios-Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany.Department of Hematology, Oncology and Stem Cell Transplantation, Asklepios Hospital St. Georg, Hamburg, Germany.Department of Hematology/Oncology and Stem Cell Transplantation, University Medical Center, Freiburg, Germany.Department of Hematology, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre Bénite, France.Department of Medicine A, University of Muenster, Munster, Germany.Departments of Hematology/Oncology, Charles University Hospital, Pilsen, Czech Republic.Charité Universitatsmedizin, 10117, Berlin, Germany.University Medical Center Hamburg-Eppendorf, Hamburg, Germany.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.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.

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

27639553

Citation

Ruggeri, Annalisa, et al. "Unrelated Donor Versus Matched Sibling Donor in Adults With Acute Myeloid Leukemia in First Relapse: an ALWP-EBMT Study." Journal of Hematology & Oncology, vol. 9, no. 1, 2016, p. 89.
Ruggeri A, Battipaglia G, Labopin M, et al. Unrelated donor versus matched sibling donor in adults with acute myeloid leukemia in first relapse: an ALWP-EBMT study. J Hematol Oncol. 2016;9(1):89.
Ruggeri, A., Battipaglia, G., Labopin, M., Ehninger, G., Beelen, D., Tischer, J., Ganser, A., Schwerdtfeger, R., Glass, B., Finke, J., Michallet, M., Stelljes, M., Jindra, P., Arnold, R., Kröger, N., Mohty, M., & Nagler, A. (2016). Unrelated donor versus matched sibling donor in adults with acute myeloid leukemia in first relapse: an ALWP-EBMT study. Journal of Hematology & Oncology, 9(1), 89. https://doi.org/10.1186/s13045-016-0321-y
Ruggeri A, et al. Unrelated Donor Versus Matched Sibling Donor in Adults With Acute Myeloid Leukemia in First Relapse: an ALWP-EBMT Study. J Hematol Oncol. 2016 09 17;9(1):89. PubMed PMID: 27639553.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Unrelated donor versus matched sibling donor in adults with acute myeloid leukemia in first relapse: an ALWP-EBMT study. AU - Ruggeri,Annalisa, AU - Battipaglia,Giorgia, AU - Labopin,Myriam, AU - Ehninger,Gerhard, AU - Beelen,Dietrich, AU - Tischer,Johanna, AU - Ganser,Arnold, AU - Schwerdtfeger,Rainer, AU - Glass,Bertram, AU - Finke,Jurgen, AU - Michallet,Mauricette, AU - Stelljes,Matthias, AU - Jindra,Pavel, AU - Arnold,Renate, AU - Kröger,Nicolaus, AU - Mohty,Mohamad, AU - Nagler,Arnon, Y1 - 2016/09/17/ PY - 2016/07/19/received PY - 2016/09/08/accepted PY - 2016/9/19/entrez PY - 2016/9/19/pubmed PY - 2017/12/6/medline KW - Acute myeloid leukemia KW - Matched sibling donor KW - Relapse KW - Unrelated donor SP - 89 EP - 89 JF - Journal of hematology & oncology JO - J Hematol Oncol VL - 9 IS - 1 N2 - BACKGROUND: 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. METHODS: 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. RESULTS: 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)). CONCLUSIONS: Transplantation using UD was associated with better LFS and lower RI compared to MSD for high-risk patients with AML transplanted in first relapse. SN - 1756-8722 UR - https://www.unboundmedicine.com/medline/citation/27639553/Unrelated_donor_versus_matched_sibling_donor_in_adults_with_acute_myeloid_leukemia_in_first_relapse:_an_ALWP_EBMT_study_ L2 - https://jhoonline.biomedcentral.com/articles/10.1186/s13045-016-0321-y DB - PRIME DP - Unbound Medicine ER -