TY - JOUR
T1 - One-Antigen Mismatched Related versus HLA-Matched Unrelated Donor Hematopoietic Stem Cell Transplantation in Adults with Acute Leukemia
T2 - Center for International Blood and Marrow Transplant Research Results in the Era of Molecular HLA Typing
AU - Valcárcel, David
AU - Sierra, Jorge
AU - Wang, Tao
AU - Kan, Fangyu
AU - Gupta, Vikas
AU - Hale, Gregory A.
AU - Marks, David I.
AU - McCarthy, Philip L.
AU - Oudshoorn, Machteld
AU - Petersdorf, Effie W.
AU - Ringdén, Olle
AU - Setterholm, Michelle
AU - Spellman, Stephen R.
AU - Waller, Edmund K.
AU - Gajewski, James L.
AU - Marino, Susana R.
AU - Senitzer, David
AU - Lee, Stephanie J.
N1 - Funding Information:
The CIBMTR is supported by Public Health Service Grant/Cooperative Agreement U24-CA76518 from the National Cancer Institute (NCI), the National Heart, Lung and Blood Institute (NHLBI), and the National Institute of Allergy and Infectious Diseases (NIAID) ; NHLBI/NCI Grant/Cooperative Agreement 5U01HL069294 ; Health Resources and Services Administration Contract HHSH234200637015C ; Office of Naval Research Grants N00014-06-1-0704 and N00014-08-1-0058 ; and grants from AABB, Aetna, American Society for Blood and Marrow Transplantation, Amgen , an anonymous donation to the Medical College of Wisconsin; Astellas Pharma US, Baxter International, Bayer HealthCare Pharmaceuticals, Be the Match Foundation, Biogen IDEC, BioMarin Pharmaceutical, Biovitrum AB, Blood Center of Wisconsin, Blue Cross and Blue Shield Association, Bone Marrow Foundation, Canadian Blood and Marrow Transplant Group, Caridian BCT, Celgene, CellGenix, Centers for Disease Control and Prevention, Children’s Leukemia Research Association, ClinImmune Labs, CTI Clinical Trial and Consulting Services, Cubist Pharmaceuticals, Cylex, CytoTherm, DOR BioPharma, Dynal Biotech (an Invitrogen Company), Eisai, Enzon Pharmaceuticals, European Group for Blood and Marrow Transplantation, Gamida Cell, GE Healthcare, Genentech, Genzyme, Histogenetics, HKS Medical Information Systems, Hospira, Infectious Diseases Society of America, Kiadis Pharma, Kirin Brewery Co, The Leukemia & Lymphoma Society, Merck & Company, Medical College of Wisconsin, MGI Pharma, Michigan Community Blood Centers, Millennium Pharmaceuticals, Miller Pharmacal Group, Milliman USA, Miltenyi Biotec, National Marrow Donor Program; Nature Publishing Group; New York Blood Center, Novartis Oncology, Oncology Nursing Society, Osiris Therapeutics, Otsuka America Pharmaceutical, Pall Life Sciences, PDL BioPharma, Pfizer, Pharmion, Saladax Biomedical, Schering, Society for Healthcare Epidemiology of America, StemCyte, StemSoft Software, Sysmex America, Teva Pharmaceutical Industries, THERAKOS, Thermogenesis, Vidacare, Vion Pharmaceuticals, ViraCor Laboratories, ViroPharma, and Wellpoint. The views expressed in this article do not reflect the official policy or position of the National Institutes of Health, the Department of the Navy, the Department of Defense, or any other agency of the US Government.
PY - 2011/5
Y1 - 2011/5
N2 - 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.
AB - 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.
KW - Acute lymphoblastic leukemia
KW - Acute myelogenous leukemia
KW - Allogeneic transplantation
KW - HLA match
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U2 - 10.1016/j.bbmt.2010.07.022
DO - 10.1016/j.bbmt.2010.07.022
M3 - Article
C2 - 20674756
AN - SCOPUS:79954605021
SN - 1083-8791
VL - 17
SP - 640
EP - 648
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 5
ER -