Prognostic Factors Affecting Outcome after Allogeneic Transplantation for Hematological Malignancies from Unrelated Donors: Results from a Randomized Trial
Por:
Finke, J, Schmoor, C, Bethge, WA, Ottinger, HD, Stelljes, M, Zander, AR, Volin, L, Heim, DA, Schwerdtfeger, R, Kolbe, K, Mayer, J, Maertens, JA, Linkesch, W, Holler, E, Koza, V, Bornhauser, M, Einsele, H, Bertz, H, Grishina, O, Socie, G, Sierra J., ATG-Fresenius Trial Grp
Publicada:
1 nov 2012
Resumen:
Several prognostic factors for the outcome after allogeneic hematopoietic stem-cell transplant (HSCT) from matched unrelated donors have been postulated from registry data; however, data from randomized trials are lacking. We present analyses on the effects of patient-related, donor-related, and treatment-related prognostic factors on acute GVHD (aGVHD), chronic GVHD (cGVHD), relapse, nonrelapse mortality (NRM), disease-free survival (DFS), and overall survival (OS) in a randomized, multicenter, open-label, phase III trial comparing standard graft-versus-host-disease (GVHD) prophylaxis with and without pretransplantation ATG-Fresenius (ATG-F) in 201 adult patients receiving myeloablative conditioning before HSCT from HLA-A, HLA-B antigen, HLA-DRBI, HLA-DQBI allele matched unrelated donors. High-resolution testing (allele) of HLA-A, HLA-B, and HLA-C were obtained after study closure, and the impact of an HLA 10/10 4-digit mismatch on outcome and on the treatment effect of ATG-F versus control investigated. Advanced disease was a negative factor for relapse, DFS, and OS. Donor age >= 40 adversely affected the risk of aGVHD III-IV, extensive cGVHD, and OS. Younger donors are to be preferred in unrelated donor transplantation. Advanced disease patients need special precautions to improve outcome. The degree of mismatch had no major influence on the positive effect of ATG-F on the reduction of aGVHD and cGVHD. Biol Blood Marrow Transplant 18: 1716-1726 (2012) (C) 2012 American Society for Blood and Marrow Transplantation
Filiaciones:
Finke, J:
Univ Freiburg Klinikum, Dept Hematol & Oncol, Freiburg, Germany
Schmoor, C:
Univ Freiburg Klinikum, Clin Trials Unit, Freiburg, Germany
Bethge, WA:
Univ Klinikum Tubingen, Dept Hematol & Oncol, Tubingen, Germany
Ottinger, HD:
Univ Klinikum Essen, Klin & Poliklin KMT, Essen, Germany
Stelljes, M:
Univ Klin Munster, Dept Hematol & Oncol, Munster, Germany
Zander, AR:
Univ Klinikum Hamburg Eppendorf, Dept Internal Med, Hamburg, Germany
Volin, L:
Univ Helsinki, Cent Hosp, Dept Med, Helsinki, Finland
Heim, DA:
Univ Spital Basel, Dept Hematol, Basel, Switzerland
Schwerdtfeger, R:
Stiftung Deutsch Klin Diagnost, Ctr Blood & Bone Marrow Transplantat, Wiesbaden, Germany
Kolbe, K:
Johannes Gutenberg Univ Mainz, Dept Internal Med, Univ Med, D-6500 Mainz, Germany
Mayer, J:
Univ Hosp Brno, Dept Internal Med Hematol & Oncol, Brno, Czech Republic
Masaryk Univ, Brno, Czech Republic
Maertens, JA:
IK UZ Gasthuisberg, Dept Hematol, Louvain, Belgium
Linkesch, W:
Univ Klinikum Graz, Dept Hematol, Graz, Austria
Holler, E:
Klinikum Univ Regensburg, Dept Hematol & Oncol, Regensburg, Germany
Koza, V:
Charles Univ Hosp, Dept Hematol & Oncol, Plzen, Czech Republic
Bornhauser, M:
Univ Klinikum Carl Gustav Carus, Ctr Bone Marrow Transplantat, Dresden, Germany
Einsele, H:
Univ Klin Wurzburg, Med Klin & Poliklin 2, Wurzburg, Germany
Bertz, H:
Univ Freiburg Klinikum, Dept Hematol & Oncol, Freiburg, Germany
Grishina, O:
Univ Freiburg Klinikum, Clin Trials Unit, Freiburg, Germany
Socie, G:
Hop St Louis, Serv Hematol Greffe de Moelle, Paris, France
Sierra J.:
Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
Hybrid Gold
|