Journal of Hematology & Oncology (Jun 2017)

Comparison of matched sibling donors versus unrelated donors in allogeneic stem cell transplantation for primary refractory acute myeloid leukemia: a study on behalf of the Acute Leukemia Working Party of the EBMT

  • Eolia Brissot,
  • Myriam Labopin,
  • Matthias Stelljes,
  • Gerhard Ehninger,
  • Rainer Schwerdtfeger,
  • Jürgen Finke,
  • Hans-Jochem Kolb,
  • Arnold Ganser,
  • Kerstin Schäfer-Eckart,
  • Axel R. Zander,
  • Donald Bunjes,
  • Stephan Mielke,
  • Wolfgang A. Bethge,
  • Noël Milpied,
  • Peter Kalhs,
  • Igor-Woflgang Blau,
  • Nicolaus Kröger,
  • Antonin Vitek,
  • Martin Gramatzki,
  • Ernst Holler,
  • Christoph Schmid,
  • Jordi Esteve,
  • Mohamad Mohty,
  • Arnon Nagler

DOI
https://doi.org/10.1186/s13045-017-0498-8
Journal volume & issue
Vol. 10, no. 1
pp. 1 – 10

Abstract

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Abstract Background Primary refractory acute myeloid leukemia (PRF-AML) is associated with a dismal prognosis. Allogeneic stem cell transplantation (HSCT) in active disease is an alternative therapeutic strategy. The increased availability of unrelated donors together with the significant reduction in transplant-related mortality in recent years have opened the possibility for transplantation to a larger number of patients with PRF-AML. Moreover, transplant from unrelated donors may be associated with stronger graft-mediated anti-leukemic effect in comparison to transplantations from HLA-matched sibling donor, which may be of importance in the setting of PRF-AML. Methods The current study aimed to address the issue of HSCT for PRF-AML and to compare the outcomes of HSCT from matched sibling donors (n = 660) versus unrelated donors (n = 381), for patients with PRF-AML between 2000 and 2013. The Kaplan-Meier estimator, the cumulative incidence function, and Cox proportional hazards regression models were used where appropriate. Results HSCT provide patients with PRF-AML a 2-year leukemia-free survival and overall survival of about 25 and 30%, respectively. In multivariate analysis, two predictive factors, cytogenetics and time from diagnosis to transplant, were associated with lower leukemia-free survival, whereas Karnofsky performance status at transplant ≥90% was associated with better leukemia-free survival (LFS). Concerning relapse incidence, cytogenetics and time from diagnosis to transplant were associated with increased relapse. Reduced intensity conditioning regimen was the only factor associated with lower non-relapse mortality. Conclusions HSCT was able to rescue about one quarter of the patients with PRF-AML. The donor type did not have any impact on PRF patients’ outcomes. In contrast, time to transplant was a major prognostic factor for LFS. For patients with PRF-AML who do not have a matched sibling donor, HSCT from an unrelated donor is a suitable option, and therefore, initiation of an early search for allocating a suitable donor is indicated.

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