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

Abstract : AbstractBackgroundData 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.MethodsWe 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.ResultsHLA 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.ConclusionsReduced 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.
Type de document :
Article dans une revue
Journal of Hematology & Oncology, 2015, 9 (1), pp.65. 〈10.1186/s13045-016-0295-9〉
Liste complète des métadonnées

Littérature citée [42 références]  Voir  Masquer  Télécharger

http://www.hal.inserm.fr/inserm-01351228
Contributeur : Bmc Bmc <>
Soumis le : mercredi 3 août 2016 - 08:03:04
Dernière modification le : mercredi 21 mars 2018 - 18:57:35
Document(s) archivé(s) le : mardi 8 novembre 2016 - 20:10:17

Fichiers

13045_2016_Article_295.pdf
Publication financée par une institution

Identifiants

Collections

Citation

Marie Rubio, Bipin Savani, Myriam Labopin, Emmanuelle Polge, Dietger Niederwieser, et al.. 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. Journal of Hematology & Oncology, 2015, 9 (1), pp.65. 〈10.1186/s13045-016-0295-9〉. 〈inserm-01351228〉

Partager

Métriques

Consultations de la notice

109

Téléchargements de fichiers

87