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Comparing outcomes of matched related donor and matched unrelated donor hematopoietic cell transplants in adults with B-Cell acute lymphoblastic leukemia.
Cancer. 2017 Sep 01; 123(17):3346-3355.C

Abstract

BACKGROUND

Allogeneic hematopoietic cell transplantation (HCT) using human leukocyte antigen (HLA)-matched related donors (RDs) and allogeneic HCT using HLA-matched unrelated donors (URDs) produce similar outcomes for patients with acute myelogenous leukemia, whereas the donor source has been reported to be a predictor of outcomes in myelodysplastic syndrome.

METHODS

Post-HCT outcomes for 1458 acute lymphoblastic leukemia patients from 2000 to 2011 were analyzed, and RD and URD transplants were compared.

RESULTS

The median age was 37 years (range, 18-69 years). In the multivariate analysis, HLA 8/8 allele-matched URD recipients had similar transplant-related mortality (TRM) and all-cause mortality in comparison with RD recipients (hazard ratios [HRs], 1.16 [95% confidence interval (CI), 0.91-1.48] and 1.01 [95% CI, 0.85-1.19], respectively); 7/8 URD recipients had a greater risk of TRM and all-cause mortality in comparison with RD recipients (HRs, 1.92 [95% CI, 1.47-2.52] and 1.29 [95% CI, 1.05-1.58], respectively). The risk of TRM and all-cause mortality was also greater for 7/8 URD recipients versus 8/8 URD recipients. Compared with RD recipients, both 8/8 and 7/8 URD recipients had a lower risk of relapse (HRs, 0.77 [95% CI, 0.62-0.97] and 0.75 [95% CI, 0.56-1.00], respectively). Both 8/8 and 7/8 URD recipients had a greater risk of acute graft-versus-host disease (GVHD; HRs, 2.18 [95% CI, 1.76-2.70] and 2.65 [95% CI, 2.06-3.42], respectively) and chronic GVHD (HRs, 1.28 [95% CI, 1.06-1.55] and 1.46 [95% CI, 1.14-1.88], respectively) in comparison with RD recipients.

CONCLUSIONS

In the absence of RD transplantation, 8/8 URD transplantation is a viable alternative with similar survival outcomes, whereas 7/8 URD transplantation is associated with poorer overall survival. Cancer 2017;123:3346-55. © 2017 American Cancer Society.

Authors+Show Affiliations

Medical College of Wisconsin Affiliated Hospitals, Milwaukee, Wisconsin.Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin.Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin.Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota.Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, Washington.Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia.University Hospitals Case Medical Center, Cleveland, Ohio.Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

28452054

Citation

Segal, Eric, et al. "Comparing Outcomes of Matched Related Donor and Matched Unrelated Donor Hematopoietic Cell Transplants in Adults With B-Cell Acute Lymphoblastic Leukemia." Cancer, vol. 123, no. 17, 2017, pp. 3346-3355.
Segal E, Martens M, Wang HL, et al. Comparing outcomes of matched related donor and matched unrelated donor hematopoietic cell transplants in adults with B-Cell acute lymphoblastic leukemia. Cancer. 2017;123(17):3346-3355.
Segal, E., Martens, M., Wang, H. L., Brazauskas, R., Weisdorf, D., Sandmaier, B. M., Khoury, H. J., de Lima, M., & Saber, W. (2017). Comparing outcomes of matched related donor and matched unrelated donor hematopoietic cell transplants in adults with B-Cell acute lymphoblastic leukemia. Cancer, 123(17), 3346-3355. https://doi.org/10.1002/cncr.30737
Segal E, et al. Comparing Outcomes of Matched Related Donor and Matched Unrelated Donor Hematopoietic Cell Transplants in Adults With B-Cell Acute Lymphoblastic Leukemia. Cancer. 2017 Sep 1;123(17):3346-3355. PubMed PMID: 28452054.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparing outcomes of matched related donor and matched unrelated donor hematopoietic cell transplants in adults with B-Cell acute lymphoblastic leukemia. AU - Segal,Eric, AU - Martens,Michael, AU - Wang,Hai-Lin, AU - Brazauskas,Ruta, AU - Weisdorf,Daniel, AU - Sandmaier,Brenda M, AU - Khoury,H Jean, AU - de Lima,Marcos, AU - Saber,Wael, Y1 - 2017/04/27/ PY - 2016/12/12/received PY - 2017/03/06/revised PY - 2017/03/21/accepted PY - 2017/4/30/pubmed PY - 2017/10/5/medline PY - 2017/4/29/entrez KW - acute lymphoblastic leukemia (ALL) KW - allogeneic transplantation KW - human leukocyte antigen (HLA) match KW - related donors KW - stem cell transplantation KW - unrelated donors SP - 3346 EP - 3355 JF - Cancer JO - Cancer VL - 123 IS - 17 N2 - BACKGROUND: Allogeneic hematopoietic cell transplantation (HCT) using human leukocyte antigen (HLA)-matched related donors (RDs) and allogeneic HCT using HLA-matched unrelated donors (URDs) produce similar outcomes for patients with acute myelogenous leukemia, whereas the donor source has been reported to be a predictor of outcomes in myelodysplastic syndrome. METHODS: Post-HCT outcomes for 1458 acute lymphoblastic leukemia patients from 2000 to 2011 were analyzed, and RD and URD transplants were compared. RESULTS: The median age was 37 years (range, 18-69 years). In the multivariate analysis, HLA 8/8 allele-matched URD recipients had similar transplant-related mortality (TRM) and all-cause mortality in comparison with RD recipients (hazard ratios [HRs], 1.16 [95% confidence interval (CI), 0.91-1.48] and 1.01 [95% CI, 0.85-1.19], respectively); 7/8 URD recipients had a greater risk of TRM and all-cause mortality in comparison with RD recipients (HRs, 1.92 [95% CI, 1.47-2.52] and 1.29 [95% CI, 1.05-1.58], respectively). The risk of TRM and all-cause mortality was also greater for 7/8 URD recipients versus 8/8 URD recipients. Compared with RD recipients, both 8/8 and 7/8 URD recipients had a lower risk of relapse (HRs, 0.77 [95% CI, 0.62-0.97] and 0.75 [95% CI, 0.56-1.00], respectively). Both 8/8 and 7/8 URD recipients had a greater risk of acute graft-versus-host disease (GVHD; HRs, 2.18 [95% CI, 1.76-2.70] and 2.65 [95% CI, 2.06-3.42], respectively) and chronic GVHD (HRs, 1.28 [95% CI, 1.06-1.55] and 1.46 [95% CI, 1.14-1.88], respectively) in comparison with RD recipients. CONCLUSIONS: In the absence of RD transplantation, 8/8 URD transplantation is a viable alternative with similar survival outcomes, whereas 7/8 URD transplantation is associated with poorer overall survival. Cancer 2017;123:3346-55. © 2017 American Cancer Society. SN - 1097-0142 UR - https://www.unboundmedicine.com/medline/citation/28452054/Comparing_outcomes_of_matched_related_donor_and_matched_unrelated_donor_hematopoietic_cell_transplants_in_adults_with_B_Cell_acute_lymphoblastic_leukemia_ L2 - https://doi.org/10.1002/cncr.30737 DB - PRIME DP - Unbound Medicine ER -