Tags

Type your tag names separated by a space and hit enter

Comparison of matched sibling donors versus unrelated donors in allogeneic stem cell transplantation for primary refractory acute myeloid leukemia: a study on behalf of the Acute Leukemia Working Party of the EBMT.
J Hematol Oncol. 2017 06 24; 10(1):130.JH

Abstract

BACKGROUND

Primary refractory acute myeloid leukemia (PRF-AML) is associated with a dismal prognosis. Allogeneic stem cell transplantation (HSCT) in active disease is an alternative therapeutic strategy. The increased availability of unrelated donors together with the significant reduction in transplant-related mortality in recent years have opened the possibility for transplantation to a larger number of patients with PRF-AML. Moreover, transplant from unrelated donors may be associated with stronger graft-mediated anti-leukemic effect in comparison to transplantations from HLA-matched sibling donor, which may be of importance in the setting of PRF-AML.

METHODS

The current study aimed to address the issue of HSCT for PRF-AML and to compare the outcomes of HSCT from matched sibling donors (n = 660) versus unrelated donors (n = 381), for patients with PRF-AML between 2000 and 2013. The Kaplan-Meier estimator, the cumulative incidence function, and Cox proportional hazards regression models were used where appropriate.

RESULTS

HSCT provide patients with PRF-AML a 2-year leukemia-free survival and overall survival of about 25 and 30%, respectively. In multivariate analysis, two predictive factors, cytogenetics and time from diagnosis to transplant, were associated with lower leukemia-free survival, whereas Karnofsky performance status at transplant ≥90% was associated with better leukemia-free survival (LFS). Concerning relapse incidence, cytogenetics and time from diagnosis to transplant were associated with increased relapse. Reduced intensity conditioning regimen was the only factor associated with lower non-relapse mortality.

CONCLUSIONS

HSCT was able to rescue about one quarter of the patients with PRF-AML. The donor type did not have any impact on PRF patients' outcomes. In contrast, time to transplant was a major prognostic factor for LFS. For patients with PRF-AML who do not have a matched sibling donor, HSCT from an unrelated donor is a suitable option, and therefore, initiation of an early search for allocating a suitable donor is indicated.

Authors+Show Affiliations

Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, APHP, 184 rue du faubourg Saint-Antoine, 75571, Paris, Cedex 12, France. eolia.brissot@gmail.com.Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, APHP, 184 rue du faubourg Saint-Antoine, 75571, Paris, Cedex 12, France. Acute Leukemia Working Party Office, Hôpital Saint Antoine, APHP, Paris, France.Department of Medicine A/Hematology and Oncology, University of Muenster, Muenster, Germany.Medizinische Klinik und Poliklinik I, Universitätsklinikum, Dresden, Germany.Deutsche Klinik für Diagnostik, KMY, Zentrum, Wiesbaden, Germany.Faculty of Medicine and Medical Center, Hematology, Oncology and Stem Cell Transplantation, University of Freiburg, Freiburg im Breisgau, Germany.Klinikum Grosshadern, Med. Klinik III, München, Germany.Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany.Medizische Klinik, Paracelsus Medizinische Privatuniversität, Nürnberg, Germany.Bone Marrow Transplantation Center, University Hospital Eppendorf, Hamburg, Germany.Klinik fuer Innere Medizin III, Universtätklinikum, Ulm, Germany.Department of Internal Medicine II, Würzburg University Medical Center, Würzburg, Germany.Medical Department, Hematology and Oncology, University of Tuebingen, Tübingen, Germany.Hematology, CHU de Bordeaux, Bordeaux, France.Department of Internal Medicine I, Bone Marrow Transplantation Unit, Medical University of Vienna, Vienna, Austria.Charite-Campus Benjamin Franklin Universitaetsmedizin Berlin Klinik III- Hematologie u Onkologie, Hindenburgdamm, Berlin, Germany.Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.Department of Clinical Hematology, Institute of Hematology and Blood Transfusion, Prague, Czech Republic.Division of Stem Cell Transplantation and Immunotherapy, University of Kiel, Kiel, Germany.Department of Haematology/Oncology, University Hospital Regensburg, Regensburg, Germany.Medizinische Klinik Klinikum, Augsburg, Germany.Hospital Clinic Institut d'investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, APHP, 184 rue du faubourg Saint-Antoine, 75571, Paris, Cedex 12, France. Acute Leukemia Working Party Office, Hôpital Saint Antoine, APHP, Paris, France.Acute Leukemia Working Party Office, Hôpital Saint Antoine, APHP, Paris, France. Chaim Sheba Medical Center, Tel Hashomer, Israel.

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study

Language

eng

PubMed ID

28646908

Citation

Brissot, Eolia, et al. "Comparison of Matched Sibling Donors Versus Unrelated Donors in Allogeneic Stem Cell Transplantation for Primary Refractory Acute Myeloid Leukemia: a Study On Behalf of the Acute Leukemia Working Party of the EBMT." Journal of Hematology & Oncology, vol. 10, no. 1, 2017, p. 130.
Brissot E, Labopin M, Stelljes M, et al. Comparison of matched sibling donors versus unrelated donors in allogeneic stem cell transplantation for primary refractory acute myeloid leukemia: a study on behalf of the Acute Leukemia Working Party of the EBMT. J Hematol Oncol. 2017;10(1):130.
Brissot, E., Labopin, M., Stelljes, M., Ehninger, G., Schwerdtfeger, R., Finke, J., Kolb, H. J., Ganser, A., Schäfer-Eckart, K., Zander, A. R., Bunjes, D., Mielke, S., Bethge, W. A., Milpied, N., Kalhs, P., Blau, I. W., Kröger, N., Vitek, A., Gramatzki, M., ... Nagler, A. (2017). Comparison of matched sibling donors versus unrelated donors in allogeneic stem cell transplantation for primary refractory acute myeloid leukemia: a study on behalf of the Acute Leukemia Working Party of the EBMT. Journal of Hematology & Oncology, 10(1), 130. https://doi.org/10.1186/s13045-017-0498-8
Brissot E, et al. Comparison of Matched Sibling Donors Versus Unrelated Donors in Allogeneic Stem Cell Transplantation for Primary Refractory Acute Myeloid Leukemia: a Study On Behalf of the Acute Leukemia Working Party of the EBMT. J Hematol Oncol. 2017 06 24;10(1):130. PubMed PMID: 28646908.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of matched sibling donors versus unrelated donors in allogeneic stem cell transplantation for primary refractory acute myeloid leukemia: a study on behalf of the Acute Leukemia Working Party of the EBMT. AU - Brissot,Eolia, AU - Labopin,Myriam, AU - Stelljes,Matthias, AU - Ehninger,Gerhard, AU - Schwerdtfeger,Rainer, AU - Finke,Jürgen, AU - Kolb,Hans-Jochem, AU - Ganser,Arnold, AU - Schäfer-Eckart,Kerstin, AU - Zander,Axel R, AU - Bunjes,Donald, AU - Mielke,Stephan, AU - Bethge,Wolfgang A, AU - Milpied,Noël, AU - Kalhs,Peter, AU - Blau,Igor-Woflgang, AU - Kröger,Nicolaus, AU - Vitek,Antonin, AU - Gramatzki,Martin, AU - Holler,Ernst, AU - Schmid,Christoph, AU - Esteve,Jordi, AU - Mohty,Mohamad, AU - Nagler,Arnon, Y1 - 2017/06/24/ PY - 2017/05/01/received PY - 2017/06/16/accepted PY - 2017/6/26/entrez PY - 2017/6/26/pubmed PY - 2018/1/4/medline KW - Acute myeloid leukemia KW - Allogeneic stem cell transplantation KW - Graft-versus-host disease KW - HLA-matched related donor KW - Refractory KW - Unrelated donor SP - 130 EP - 130 JF - Journal of hematology & oncology JO - J Hematol Oncol VL - 10 IS - 1 N2 - BACKGROUND: Primary refractory acute myeloid leukemia (PRF-AML) is associated with a dismal prognosis. Allogeneic stem cell transplantation (HSCT) in active disease is an alternative therapeutic strategy. The increased availability of unrelated donors together with the significant reduction in transplant-related mortality in recent years have opened the possibility for transplantation to a larger number of patients with PRF-AML. Moreover, transplant from unrelated donors may be associated with stronger graft-mediated anti-leukemic effect in comparison to transplantations from HLA-matched sibling donor, which may be of importance in the setting of PRF-AML. METHODS: The current study aimed to address the issue of HSCT for PRF-AML and to compare the outcomes of HSCT from matched sibling donors (n = 660) versus unrelated donors (n = 381), for patients with PRF-AML between 2000 and 2013. The Kaplan-Meier estimator, the cumulative incidence function, and Cox proportional hazards regression models were used where appropriate. RESULTS: HSCT provide patients with PRF-AML a 2-year leukemia-free survival and overall survival of about 25 and 30%, respectively. In multivariate analysis, two predictive factors, cytogenetics and time from diagnosis to transplant, were associated with lower leukemia-free survival, whereas Karnofsky performance status at transplant ≥90% was associated with better leukemia-free survival (LFS). Concerning relapse incidence, cytogenetics and time from diagnosis to transplant were associated with increased relapse. Reduced intensity conditioning regimen was the only factor associated with lower non-relapse mortality. CONCLUSIONS: HSCT was able to rescue about one quarter of the patients with PRF-AML. The donor type did not have any impact on PRF patients' outcomes. In contrast, time to transplant was a major prognostic factor for LFS. For patients with PRF-AML who do not have a matched sibling donor, HSCT from an unrelated donor is a suitable option, and therefore, initiation of an early search for allocating a suitable donor is indicated. SN - 1756-8722 UR - https://www.unboundmedicine.com/medline/citation/28646908/Comparison_of_matched_sibling_donors_versus_unrelated_donors_in_allogeneic_stem_cell_transplantation_for_primary_refractory_acute_myeloid_leukemia:_a_study_on_behalf_of_the_Acute_Leukemia_Working_Party_of_the_EBMT_ L2 - https://jhoonline.biomedcentral.com/articles/10.1186/s13045-017-0498-8 DB - PRIME DP - Unbound Medicine ER -