TY - JOUR
T1 - HLA-identical sibling compared with 8/8 matched and mismatched unrelated donor bone marrow transplant for chronic phase chronic myeloid leukemia
AU - Arora, Mukta
AU - Weisdorf, Daniel J.
AU - Spellman, Stephen R.
AU - Haagenson, Michael D.
AU - Klein, John P.
AU - Hurley, Carolyn K.
AU - Selby, George B.
AU - Antin, Joseph H.
AU - Kernan, Nancy A.
AU - Kollman, Craig
AU - Nademanee, Auayporn
AU - McGlave, Philip
AU - Horowitz, Mary M.
AU - Petersdorf, Effie W.
N1 - Funding Information:
This work was partially supported by the National Science Foundation through award ECS-9624628 and the U.S. Army Research Office under grant DAAD19-99-1-0093. The authors also wish to acknowledge the Computational Physics Group of HRL Laboratories, Malibu, CA, for their pioneering contributions to the devopemenlt of tehNy sömtmrethod for electromagnetic scattering analysis.
PY - 2009/4/1
Y1 - 2009/4/1
N2 - Purpose Transplantation of hematopoietic stem cells from an unrelated donor (URD) is an option for many patients who do not have an HLA-identical sibling donor (MSD). Current criteria for the selection of URDs include consideration for HLA alleles determined by high resolution typing methods, with preference for allele-matched donors. However, the utility and outcome associated with transplants from URDs compared with those from MSDs remains undefined. Patients and Methods We examined clinical outcome after patients received bone marrow transplants (BMTs) from MSDs; HLA-A, -B, -C, and DRB1 allele-matched URDs (8/8); and HLA-mismatched URDs in a homogeneous population of patients with chronic myeloid leukemia (CML) in first chronic phase (CP1) where a strong allogeneic effect and hence a lower risk of relapse is anticipated. Transplantation outcomes were compared between 1,052 URD and 3,514 MSD BMT recipients with CML in CP1. Results Five-year overall survival and leukemia-free survival (LFS) after receipt of BMTs from 8/8 matched URDs were worse than those after receipt of BMTs from MSDs (5-year survival, 55% v 63%; RR, 1.35; 95% CI, 1.17 to 1.56; P<.001; LFS, 50% v 55%; RR, 1.21; 95% CI, 1.06 to 1.40; P =.006). Survival was progressively worse with greater degrees of mismatch. Similar and low risk of relapse were observed after receipt of transplant from either MSD or URD. Conclusion In this homogeneous cohort of good risk patients with CML in CP1, 5-year overall survival and LFS after receipt of transplant from 8/8 allele-matched donors were modestly though significantly worse than those after receipt of transplant from MSDs. Additive adverse effects of multilocus mismatching are not well tolerated and should be avoided if possible.
AB - Purpose Transplantation of hematopoietic stem cells from an unrelated donor (URD) is an option for many patients who do not have an HLA-identical sibling donor (MSD). Current criteria for the selection of URDs include consideration for HLA alleles determined by high resolution typing methods, with preference for allele-matched donors. However, the utility and outcome associated with transplants from URDs compared with those from MSDs remains undefined. Patients and Methods We examined clinical outcome after patients received bone marrow transplants (BMTs) from MSDs; HLA-A, -B, -C, and DRB1 allele-matched URDs (8/8); and HLA-mismatched URDs in a homogeneous population of patients with chronic myeloid leukemia (CML) in first chronic phase (CP1) where a strong allogeneic effect and hence a lower risk of relapse is anticipated. Transplantation outcomes were compared between 1,052 URD and 3,514 MSD BMT recipients with CML in CP1. Results Five-year overall survival and leukemia-free survival (LFS) after receipt of BMTs from 8/8 matched URDs were worse than those after receipt of BMTs from MSDs (5-year survival, 55% v 63%; RR, 1.35; 95% CI, 1.17 to 1.56; P<.001; LFS, 50% v 55%; RR, 1.21; 95% CI, 1.06 to 1.40; P =.006). Survival was progressively worse with greater degrees of mismatch. Similar and low risk of relapse were observed after receipt of transplant from either MSD or URD. Conclusion In this homogeneous cohort of good risk patients with CML in CP1, 5-year overall survival and LFS after receipt of transplant from 8/8 allele-matched donors were modestly though significantly worse than those after receipt of transplant from MSDs. Additive adverse effects of multilocus mismatching are not well tolerated and should be avoided if possible.
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U2 - 10.1200/JCO.2008.18.7740
DO - 10.1200/JCO.2008.18.7740
M3 - Article
C2 - 19224849
AN - SCOPUS:63749113237
SN - 0732-183X
VL - 27
SP - 1644
EP - 1652
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 10
ER -