One-Antigen Mismatched Related versus HLA-Matched Unrelated Donor Hematopoietic Stem Cell Transplantation in Adults with Acute Leukemia: Center for International Blood and Marrow Transplant Research Results in the Era of Molecular HLA Typing
Por:
Valcárcel D., Sierra J., Wang T., Kan F., Gupta V., Hale G.A., Marks D.I., McCarthy P.L., Oudshoorn M., Petersdorf E.W., Ringdén O., Setterholm M., Spellman S.R., Waller E.K., Gajewski J.L., Marino S.R., Senitzer D., Lee S.J.
Publicada:
1 ene 2011
Resumen:
Approximately 13% of patients lacking an HLA-identical sibling have a one-antigen-mismatched related donor (MMRD). Historically, outcomes from the use of a one-antigen MMRD were considered equivalent to those from the use of a matched unrelated donor (UD). Recent improvements in UD stem cell transplantation (SCT) resulting from better molecular HLA matching justifies investigating whether UD should be preferred over MMRD in adult patients with acute leukemia. Here, we compared the outcomes of MMRD (n = 89) and HLA-A, -B, -C, and -DRB1 allele-matched UD (n = 700) SCT reported to the Center for International Blood and Marrow Transplant Research between 1995 and 2005. The patients underwent transplantation for acute myelogenous leukemia or acute lymphoblastic leukemia in first or second complete remission. Donor type was not associated with hematologic recovery. Univariate and multivariate comparisons of MMRD versus HLA-matched UD transplants showed no statistically significant differences in overall survival, disease-free survival, treatment-related mortality, relapse, or 100-day grade III-IV acute graft-versus-host disease (GVHD). MMRD SCT was associated with a lower rate of chronic GVHD at 1 year (35% vs 47%; P = .03), which was confirmed by multivariate analysis (relative risk, 0.58; 95% confidence interval, 0.39-0.85; P < .01). According to our data, HLA-matched UD and MMRD SCT are associated with comparable survival. Given that less chronic GVHD was observed in the MMRD transplantations, this option, when available, remains the first choice in patients with acute leukemia without an HLA-identical sibling in need of allogeneic SCT. © 2011 American Society for Blood and Marrow Transplantation.
Filiaciones:
Valcárcel D.:
Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Sierra J.:
Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Wang T.:
Center for International Blood and Marrow Transplant Research, Milwaukee, WI, United States
Kan F.:
Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Center for International Blood and Marrow Transplant Research, Minneapolis, MI, United States
Gupta V.:
Princess Margaret Hospital, Toronto, Canada
Hale G.A.:
St Jude Children's Research Hospital, Memphis, TN, United States
Marks D.I.:
University of Bristol, Bristol, United Kingdom
McCarthy P.L.:
Rosewell Park Cancer Institute, Buffalo New York, United States
Oudshoorn M.:
Euopdonor Foundation, Leiden, Netherlands
Petersdorf E.W.:
Fred Hutchinson Cancer Research Center, Seattle, WA, United States
Ringdén O.:
Center for Allogeneic Stem Cell Transplantation, Karolinska University, Stockholm, Sweden
Setterholm M.:
National Marrow Donor Program, Minneapolis, MN, United States
Spellman S.R.:
Center for International Blood and Marrow Transplant Research, Minneapolis, MI, United States
National Marrow Donor Program, Minneapolis, MN, United States
Waller E.K.:
Emory University, Atlanta, GA, United States
Gajewski J.L.:
Oregon Health and Science University, Portland, OR, United States
Marino S.R.:
University of Chicago, Chicago, IL, United States
Senitzer D.:
City of Hope, Duarte, CA, United States
Lee S.J.:
Fred Hutchinson Cancer Research Center, Seattle, WA, United States
Green Accepted, Hybrid Gold, Green
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