Comparing outcomes of matched related donor and matched unrelated donor hematopoietic cell transplants in adults with B‐Cell acute lymphoblastic leukemia

Authors:
Open Access
Publisher website
Google Scholar
Abstract
BACKGROUND: Allogeneic hematopoietic cell transplantation (HCT) using human leukocyte antigen (HLA)–matched related donors (RDs) and allogeneic HCT using HLA‐matched unrelated donors (URDs) produce similar outcomes for patients with acute myelogenous leukemia, whereas the donor source has been reported to be a predictor of outcomes in myelodysplastic syndrome.METHODS: Post‐HCT outcomes for 1458 acute lymphoblastic leukemia patients from 2000 to 2011 were analyzed, and RD and URD transplants were compared.RESULTS: The median age was 37 years (range, 18‐69 years). In the multivariate analysis, HLA 8/8 allele–matched URD recipients had similar transplant‐related mortality (TRM) and all‐cause mortality in comparison with RD recipients (hazard ratios [HRs], 1.16 [95% confidence interval (CI), 0.91‐1.48] and 1.01 [95% CI, 0.85‐1.19], respectively); 7/8 URD recipients had a greater risk of TRM and all‐cause mortality in comparison with RD recipients (HRs, 1.92 [95% CI, 1.47‐2.52] and 1.29 [95% CI, 1.05‐1.58], respectively). The risk of TRM and all‐cause mortality was also greater for 7/8 URD recipients versus 8/8 URD recipients. Compared with RD recipients, both 8/8 and 7/8 URD recipients had a lower risk of relapse (HRs, 0.77 [95% CI, 0.62‐0.97] and 0.75 [95% CI, 0.56‐1.00], respectively). Both 8/8 and 7/8 URD recipients had a greater risk of acute graft‐versus‐host disease (GVHD; HRs, 2.18 [95% CI, 1.76‐2.70] and 2.65 [95% CI, 2.06‐3.42], respectively) and chronic GVHD (HRs, 1.28 [95% CI, 1.06‐1.55] and 1.46 [95% CI, 1.14‐1.88], respectively) in comparison with RD recipients.CONCLUSIONS: In the absence of RD transplantation, 8/8 URD transplantation is a viable alternative with similar survival outcomes, whereas 7/8 URD transplantation is associated with poorer overall survival. Cancer 2017;123:3346‐55. © 2017 American Cancer Society.
Funding Information
  • National Heart, Lung, and Blood Institute (5U10HL069294)
  • Health Resources and Services Administration (HHSH250201200016C, N00014‐13‐1‐0039, N00014‐14‐1‐0028)
  • Office of Naval Research

This publication has 27 references indexed in Scilit: