Alternative Donor Transplantation for Older Patients with Acute Myeloid Leukemia in First Complete Remission: A Center for International Blood and Marrow Transplant Research-Eurocord Analysis

被引:68
|
作者
Weisdorf, Daniel [1 ,2 ]
Eapen, Mary [2 ]
Ruggeri, Annalisa [3 ,4 ]
Zhang, Mei-Jie [2 ,3 ,5 ]
Zhong, Xiaobo [5 ]
Brunstein, Claudio [1 ]
Ustun, Celalettin [1 ]
Rocha, Vanderson [3 ,6 ]
Gluckman, Eliane [3 ,7 ]
机构
[1] Univ Minnesota, Blood & Marrow Transplant Program, Dept Med, Minneapolis, MN 55455 USA
[2] Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA
[3] Hop St Louis, Eurocord, Paris, France
[4] Hop St Antoine, Serv Hematol & Therapie Cellulaire, F-75571 Paris, France
[5] Med Coll Wisconsin, Div Biostat, Milwaukee, WI 53226 USA
[6] Oxford Univ Hosp NHS Trust, Dept Clin Haematol, Churchill Hosp, Oxford, England
[7] Univ Paris Diderot, Paris, France
关键词
Allogeneic transplantation; Acute myeloid leukemia; Umbilical cord blood; Unrelated donors; HEMATOPOIETIC-CELL TRANSPLANTATION; ACUTE MYELOGENOUS LEUKEMIA; UMBILICAL-CORD BLOOD; VERSUS-HOST-DISEASE; CYTOKINE GENE POLYMORPHISMS; REDUCED-INTENSITY; MYELODYSPLASTIC SYNDROME; UNRELATED DONOR; ELDERLY-PATIENTS; RETROSPECTIVE ANALYSIS;
D O I
10.1016/j.bbmt.2014.02.020
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
We studied patients with acute myeloid leukemia (AML) over age 50 and in first complete remission (CR1) after adult unrelated donor (URD) (n = 441, 8/8 HLA matched; n = 94, 7/8 HLA matched) or umbilical cord blood (UCB; n = 205) transplantations. UCB recipients achieved CR1 within 8 weeks less often, and received reduced-intensity conditioning and cyclosporine-based graft-versus-host disease (GVHD) prophylaxis more often. Neutrophil recovery was slower in UCB (69% by day 28) compared with 8/8 HLA-matched URD (97%) and 7/8 HLA-matched (91%) (P < .001) recipients. Three-year transplantation-related mortality (TRM) was higher and leukemia-free survival (LFS) lower with UCB (35% and 28%, respectively) versus 8/8 HLA-matched URD (27% and 39%, respectively). TRM was higher in 7/8 HLA-matched URD (41%, P = .01), but LFS was similar at 34% (P = .39). Three-year chronic GVHD was the lowest in UCB (28%) versus 53% and 59% in 8/8 and 7/8 HLA-matched URD recipients, respectively. Three-year survival was 43% in 8/8 HLA-matched URD (95% confidence interval [CI], 38% to 48%), 30% in UCB (95% CI, 23% to 37%) (P = .002) and 37% in 7/8 URD (95% CI, 27 to 46). Allotransplantation for AML in CR1 with any of these grafts extends LFS for over one third of older patients. In the absence of an 8/8 HLA-matched URD or when transplantation is needed urgently, UCB can provide extended survival. Less frequent chronic GVHD with UCB transplantation may be of particular value for older patients. C) 2014 American Society for Blood and Marrow Transplantation.
引用
收藏
页码:816 / 822
页数:7
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