Universität zu Köln

Rubio, Marie T., Savani, Bipin N., Labopin, Myriam, Polge, Emmanuelle, Niederwieser, Dietger, Ganser, Arnold, Schwerdtfeger, Rainer, Ehninger, Gerhard, Finke, Juergen, Renate, Arnold, Craddock, Charles ORCID: 0000-0001-5041-6678, Kroeger, Nicolaus, Hallek, Michael, Jindra, Pavel, Mohty, Mohamad and Nagler, Arnon (2016). The impact of HLA-matching on reduced intensity conditioning regimen unrelated donor allogeneic stem cell transplantation for acute myeloid leukemia in patients above 50 years-a report from the EBMT acute leukemia working party. J. Hematol. Oncol., 9. LONDON: BIOMED CENTRAL LTD. ISSN 1756-8722

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Abstract

Background: Data comparing fully matched and mismatched-unrelated-donor (M-and mM-URD) allogeneic hematopoietic stem cell transplant (allo-SCT) following reduced intensity conditioning regimens for acute myeloid leukemia are limited. Methods: We retrospectively compared the outcome of 3398 patients above the age of 50 years who underwent 10/10 M-URD (n = 2567), 9/10 (n = 723), or 8/10 (n = 108) mM-URD allo-SCT for acute myeloid leukemia after reduced intensity conditioning regimen between 2000 and 2013. The Kaplan-Meier estimator, the cumulative incidence function, and Cox proportional hazards regression models were used where appropriate. Results: HLA matching had no impact on engraftment (p = 0.31). In univariate analysis, in comparison to 10/10 M-URD, mM-URD was associated with higher incidence of grade II-IV acute graft-versus-host disease (GVHD) (p = 0.0002), similar rates of chronic GVHD (p = 0.138) but increased incidence of its extensive form (p = 0.047). Compared to 10/10 M-URD, patients transplanted in the first complete remission (CR1) with a 9 or an 8/10 mM-URD had decreased 2-year leukemia free (LFS) (p = 0.005) and overall survivals (OS) (56.7, 46.1, and 50.2 %, respectively, p = 0.005), while outcomes were comparable between all groups for patients transplanted beyond CR1. In multivariate analysis, 9/10 versus 10/10 URD was associated with higher non-relapse mortality (HR 1.34, p = 0.001), similar risk of relapse and chronic GVHD and inferior LFS (HR 1.25, p = 0.0001), and OS (HR 1.27, p = 0.0001). There was no difference in adjusted transplant outcomes between 9/10 and 8/10 mM-URD. Conclusions: Reduced intensity conditioned allo-SCT with a 10/10 M-URD remains the preferable option for AML patients above the age of 50 years. The use of a 9/10 or an 8/10 mM-URD in patients not having a fully matched donor represents an alternative therapeutic option that should be compared to other alternative donor transplant strategies.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Rubio, Marie T. UNSPECIFIED UNSPECIFIED UNSPECIFIED Savani, Bipin N. UNSPECIFIED UNSPECIFIED UNSPECIFIED Labopin, Myriam UNSPECIFIED UNSPECIFIED UNSPECIFIED Polge, Emmanuelle UNSPECIFIED UNSPECIFIED UNSPECIFIED Niederwieser, Dietger UNSPECIFIED UNSPECIFIED UNSPECIFIED Ganser, Arnold UNSPECIFIED UNSPECIFIED UNSPECIFIED Schwerdtfeger, Rainer UNSPECIFIED UNSPECIFIED UNSPECIFIED Ehninger, Gerhard UNSPECIFIED UNSPECIFIED UNSPECIFIED Finke, Juergen UNSPECIFIED UNSPECIFIED UNSPECIFIED Renate, Arnold UNSPECIFIED UNSPECIFIED UNSPECIFIED Craddock, Charles UNSPECIFIED orcid.org/0000-0001-5041-6678 UNSPECIFIED Kroeger, Nicolaus UNSPECIFIED UNSPECIFIED UNSPECIFIED Hallek, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Jindra, Pavel UNSPECIFIED UNSPECIFIED UNSPECIFIED Mohty, Mohamad UNSPECIFIED UNSPECIFIED UNSPECIFIED Nagler, Arnon UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-266821
DOI:	10.1186/s13045-016-0295-9
Journal or Publication Title:	J. Hematol. Oncol.
Volume:	9
Date:	2016
Publisher:	BIOMED CENTRAL LTD
Place of Publication:	LONDON
ISSN:	1756-8722
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language BONE-MARROW-TRANSPLANTATION; ACUTE MYELOGENOUS LEUKEMIA; HEMATOLOGIC MALIGNANCIES; POSTTRANSPLANTATION CYCLOPHOSPHAMIDE; HEMATOPOIETIC TRANSPLANTATION; ELDERLY-PATIENTS; SIBLING DONORS; MYELODYSPLASTIC SYNDROME; HAPLOIDENTICAL DONORS; ALTERNATIVE DONORS Multiple languages Oncology; Hematology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/26682