Comparable survival after HLA-well-matched unrelated or matched sibling donor transplantation for acute myeloid leukemia in first remission with unfavorable cytogenetics at diagnosis
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- Vikas Gupta
- Princess Margaret Hospital, University of Toronto, Toronto, ON;
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- Martin S. Tallman
- Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, NY;
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- Wensheng He
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee;
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- Brent R. Logan
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee;
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- Edward Copelan
- Cleveland Clinic Foundation, OH;
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- Robert Peter Gale
- Celgene Corporation, Summit, NJ;
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- Hanna J. Khoury
- Emory University Hospital, Atlanta, GA;
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- Thomas Klumpp
- Fox Chase–Temple BMT Program, Philadelphia, PA;
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- John Koreth
- Dana-Farber Cancer Institute, Boston, MA;
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- Hillard M. Lazarus
- University Hospitals Case Medical Center, Cleveland, OH;
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- David I. Marks
- Bristol Children's Hospital, Bristol, United Kingdom;
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- Rodrigo Martino
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain;
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- David A. Rizzieri
- Duke University Medical Center, Durham, NC;
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- Jacob M. Rowe
- Rambam Medical Center, Haifa, Israel;
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- Mitchell Sabloff
- Ottawa Hospital Blood and Marrow Transplant Program, Ottawa, ON;
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- Edmund K. Waller
- Emory University Hospital, Atlanta, GA;
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- John F. DiPersio
- Barnes Jewish Hospital, St Louis, MO;
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- Donald W. Bunjes
- Universitatsklinikum Ulm, Ulm, Germany; and
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- Daniel J. Weisdorf
- University of Minnesota Medical Center, Minneapolis
抄録
<jats:title>Abstract</jats:title><jats:p>We compared the outcomes of unrelated donor (URD, n = 358) with human leukocyte antigen (HLA)–matched sibling donor (MSD, n = 226) transplantations in patients with acute myeloid leukemia (AML) in first complete remission (CR1) having unfavorable cytogenetics at diagnosis. Unfavorable cytogenetic abnormalities were: complex (≥ 3 abnormalities), 32%; and noncomplex involving chromosome 7, 25%; chromosome 5, 9%; 11q or MLL rearrangements, 18%; t(6;9), 5%; and other noncomplex, 10%. URDs were HLA-well-matched (n = 254; 71%) or partially-matched (n = 104; 29%). Three-year leukemia-free survival (LFS) for MSD was 42% (95% confidence interval [CI], 35%-48%) compared with 34% (95% CI, 28%-41%) for HLA-well-matched URD and 29% (95% CI, 20%-39%) for partially-matched URD (P = .08). In multivariate analysis, HLA-well-matched URD and MSD yielded similar LFS (relative risk [RR] = 1.1, 95% CI, 0.86-1.40, P = .44) and overall survival (OS; RR = 1.06, 95% CI, 0.83-1.37, P = .63). LFS and OS were significantly inferior for HLA-partially-matched URD recipients, those with prior myelodysplastic syndrome, and those older than 50 years. All cytogenetic cohorts had similar outcomes. Patients with chronic graft-versus-host disease had a significantly lower risk of relapse (RR = 0.68, 95% CI, 0.47-0.99, P = .05). Hematopoietic cell transplantation (HCT) using HLA-well-matched URD and MSD resulted in similar LFS and OS in AML patients in CR1 with unfavorable cytogenetics. Outcomes of HCT from HLA-partially- matched URD were inferior.</jats:p>
収録刊行物
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- Blood
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Blood 116 (11), 1839-1848, 2010-09-16
American Society of Hematology