Alternative donor transplantation for acute myeloid leukemia in patients aged ≥50 years: young HLA-matched unrelated or haploidentical donor?
Miguel-Angel Perales,
Benjamin Tomlinson,
Mei-Jie Zhang,
Andrew St. Martin,
Amer Beitinjaneh,
John Gibson,
William Hogan,
Natasha Kekre,
Hillard Lazarus,
David Marks,
Joseph McGuirk,
Rizwan Romee,
Melhem Solh,
John E. Wagner,
Daniel J. Weisdorf,
Marcos de Lima,
Mary Eapen
Affiliations
Miguel-Angel Perales
Adult Bone Marrow Transplant Services, Department of Medicine, Memorial Sloan-Kettering Cancer Center, and Department of Medicine, Weill Cornell Medical College, New York, NY, USA
Benjamin Tomlinson
Seidman Cancer Center, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
Mei-Jie Zhang
Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA;Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA
Andrew St. Martin
Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
Amer Beitinjaneh
UM Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
John Gibson
Institute of Haematology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
William Hogan
Bone Marrow Transplant Program, Mayo Clinic, Rochester, MN, USA
Natasha Kekre
Blood and Marrow Transplant Program, The Ottawa Hospital, Ottawa, ON, Canada
Hillard Lazarus
University Hospitals Bristol National Health Service Foundation Trust, Bristol, UK
David Marks
University Hospitals Bristol National Health Service Foundation Trust, Bristol, UK
Joseph McGuirk
Division of Hematologic Malignancies and Cellular Therapy, University of Kansas Medical Center, Kansas City, KS, USA
Rizwan Romee
Division of Hematologic Malignancies and Transplantation, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
Melhem Solh
The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA
John E. Wagner
BMT Program, University of Minnesota Masonic Children’s Hospital, Minneapolis, MN, USA
Daniel J. Weisdorf
University of Minnesota Medical Center, Minneapolis, MN, USA
Marcos de Lima
The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA
Mary Eapen
Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
We sought to study whether survival after haploidentical transplantation is comparable to that after matched unrelated donor transplantation for 822 patients aged 50-75 years with acute myeloid leukemia in first or second complete remission. One hundred and ninety-two patients received grafts from haploidentical donors (sibling 25%; offspring 75%) and 631 patients from matched unrelated donors aged 18-40 years. Patients’ and disease characteristics of the two groups were similar except that recipients of matched unrelated donor transplantation were more likely to have poor risk cytogenetics and more likely to receive myeloablative conditioning regimens. Time from documented remission to transplant did not differ by donor type. Five-year overall survival was 32% and 42% after haploidentical and matched unrelated donor transplant, respectively (P=0.04). Multivariable analysis showed higher mortality (hazard ratio 1.27, P=0.04) and relapse (hazard ratio 1.32, P=0.04) after haploidentical transplantation, with similar non-relapse mortality risks. Chronic graft-versus-host disease was higher after matched unrelated donor compared to haploidentical transplantation when bone marrow was the graft (hazard ratio 3.12, P
