[PDF][PDF] Results of allogeneic bone marrow transplants for leukemia using donors other than HLA-identical siblings

R Szydlo, JM Goldman, JP Klein, RP Gale… - Journal of clinical …, 1997 - academia.edu
R Szydlo, JM Goldman, JP Klein, RP Gale, RC Ash, FH Bach, BA Bradley, JT Casper…
Journal of clinical oncology, 1997academia.edu
Purpose: To compare outcomes of bone marrow transplants for leukemia from HLA-identical
siblings, haploidentical HLA-mismatched relatives, and HLA-matched and mismatched
unrelated donors. Patients: A total of 2,055 recipients of allogeneic bone marrow transplants
for chronic myelogenous leukemia (CML), acute myelogenous leukemia (AML), and acute
lymphoblastic leukemia (ALL) were entered onto the study. Transplants were performed
between 1985 and 1991 and reported to the International Bone Marrow Transplant Registry …
Purpose: To compare outcomes of bone marrow transplants for leukemia from HLA-identical siblings, haploidentical HLA-mismatched relatives, and HLA-matched and mismatched unrelated donors. Patients: A total of 2,055 recipients of allogeneic bone marrow transplants for chronic myelogenous leukemia (CML), acute myelogenous leukemia (AML), and acute lymphoblastic leukemia (ALL) were entered onto the study. Transplants were performed between 1985 and 1991 and reported to the International Bone Marrow Transplant Registry (IBMTR). Donors were HLA-identical siblings (n= 1,224); haploidentical relatives mismatched for one (n= 238) or two (n= 102) HLA-A,-B, or-DR antigens; or unrelated persons who were HLA-matched (n= 383) or mismatched for one HLA-A,-B, or-DR antigen (n= 108). HLA typing was performed using serologic techniques.
Results: Transplant-related mortality was significantly higerafter alternative donor transplants than after HLA-identical sibling transplants. Among patients with early leukemia (CML in chronic phase or acute leukemia in first remission), 3-year transplant-elated mortality (ąSE) was 21%+ 2% after HLA-identical sibling transplants and greater than 50% after all types of alternative donor transplants studied. Among patients with early leukemia, relative risks of treatment failure (inverse of leukemia-free survival), using HLA-identical sibling transplants as the reference group, were 2.43 (P<. 0001) with 1-HLA-antigen-mismatched related donors, 3.79 (P<. 0001) with 2-HLA-antigen-mismatched related donors, 2.11 (P<. 0001) with HLA-matched unrelated donors, and 3.33 (P<. 0001) with I-HLA-antigen-mismatched unrelated donors. For pa-tients with more advanced leukemia, differences in treatment failure were less striking: 1-HLA-antigen-mismatched relatives, 1.22 (P= not significant [NSI); 2-HLA-antigenmismatched relatives, 1.81 (P<. 0001); HLA-matched unrelated donors, 1.39 (P=. 002); and 1-HLA-antigen-mismatched unrelated donors, 1.63 (P=. 002).
Conclusion: Although transplants from alternative do-nors are effective in some patients with leukemia, treatment failure is higher than after HLA-identical sibling transplants. Outcome depends on leukemia state, donorrecipient relationship, and degree of HLA matching. In early leukemia, alternative donor transplants have a more than twofold increased risk of treatment failure compared with HLA-identical sibling transplants. This dif-ference is less in advanced leukemia.
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