Allocation to Matched Related or Unrelated Donor Results in Similar Clinical Outcomes without Increased Risk of Failure to Proceed to Transplant among Patients with Acute Myeloid Leukemia : A Retrospective Analysis from the Time of Transplant Approval
Rodríguez-Arbolí, Eduardo (Hospital Universitario Virgen del Rocío (Sevilla, Andalusia))
Márquez-Malaver, F. J. (Hospital Universitario Virgen del Rocío (Sevilla, Andalusia))
Rodríguez-Torres, N. (Hospital Universitario Virgen del Rocío (Sevilla, Andalusia))
Caballero Velazquez, Teresa (Hospital Universitario Virgen del Rocío (Sevilla, Andalusia))
Escamilla-Gómez, V. (Hospital Universitario Virgen del Rocío (Sevilla, Andalusia))
Calderón Cabrera, C (Hospital Universitario Virgen del Rocío (Sevilla, Andalusia))
Falantes-González, J. F. (Hospital Universitario Virgen del Rocío (Sevilla, Andalusia))
Solé-Rodríguez, M. (Hospital Juan Ramón Jiménez (Huelva))
García-Ramírez, P. (Hospital Universitario Virgen del Rocío (Sevilla, Andalusia))
Moya-Arnao, María (Hospital Universitario Virgen del Rocío (Sevilla, Andalusia))
Carreras, Enric (Institut Germans Trias i Pujol. Institut de Recerca contra la Leucèmia Josep Carreras)
Espigado, Ildefonso (Hospital Universitario Virgen del Rocío (Sevilla, Andalusia))
Pérez-Simón, José Antonio (Hospital Universitario Virgen del Rocío (Sevilla, Andalusia))
Universitat Autònoma de Barcelona

Date:	2019
Abstract:	Clinical outcomes after allogeneic hematopoietic stem cell transplantation (allo-SCT) from unrelated donors (URDs) approach those of matched related donor (MRD) transplants in patients with acute myeloid leukemia (AML). Yet, available data fail to account for differences in pretransplantation outcomes between these donor selection strategies. In this regard, URD allo-HSCT is associated with longer waiting times to transplantation, potentially resulting in higher probabilities of failure to reach transplant. We retrospectively analyzed 108 AML patients accepted for first allo-HSCT from the time of approval to proceed to transplant. Fifty-eight (54%) patients were initially allocated to MRD, while URD search was initiated in 50 (46%) patients. Time to transplant was longer in patients allocated to a URD when compared with patients assigned to an MRD (median 142 days versus 100 days; p <. 001). Forty-three of 58 (74%) patients in the MRD group and 35 of 50 (70%) patients in the URD group underwent transplantation (odds ratio [OR], 1. 22; p =. 63). Advanced disease status at the time of allo-HSCT approval was the only predictor of failure to reach transplantation in the multivariate analysis (OR, 4. 78; p =. 001). Disease progression was the most common cause of failure to reach allo-HSCT (66. 7%) in both the MRD and URD groups. With a median follow-up from transplantation of 14. 5 (interquartile range, 5 to 29) months, the 2-year estimate of overall survival (OS) from allo-HSCT was 46% in the MRD group and 57% in the URD group (p =. 54). There were no differences in OS according to donor type allocation in the multivariate analysis (hazard ratio, 1. 01; p =. 83). When including patients from the time of transplant approval, 2-year OS was 39% in the MRD group versus 42% in the URD group. Our study suggests that allocation of AML patients to URDs may result in comparable clinical outcomes to MRD assignment without a significant increase in the risk of failure to reach transplant.
Grants:	Instituto de Salud Carlos III CB16-12-00480
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Acute myeloid leukemia ; Matched related donor ; Unrelated donor
Published in:	Biology of blood and marrow transplantation, Vol. 25 Núm. 1 (january 2019) , p. 183-190, ISSN 1523-6536

DOI: 10.1016/j.bbmt.2018.08.019
PMID: 30153492

8 p, 906.3 KB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP) > Josep Carreras Leukaemia Research Institute
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Articles > Published articles